Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor

Abstract

We report a case of ultrasound-guided ex vivo oocyte retrieval for fertility preservation in a woman with bilateral borderline ovarian tumor, for whom conventional transvaginal oocyte retrieval was deemed unsafe because of the increased risk of malignant cell spillage. Ovarian stimulation with gonadotropins was performed. Surgery was scheduled according to the ovarian response to exogenous gonadotropic stimulation; oophorectomized specimens were obtained by laparoscopy, and oocyte retrieval was performed ∼ 37 hours after the ovulatory trigger. The sum of 20 ovarian follicles were aspirated, and 16 oocytes were obtained. We performed vitrification of 12 metaphase II oocytes and 3 oocytes matured in vitro. Our result emphasizes the viability of ex vivo mature oocyte retrieval after controlled ovarian stimulation for those with high risk of malignant dissemination by conventional approach.

Successful pregnancy using immature oocytes retrieved from resected borderline ovarian tumor: a case report and literature review

“…To increase the number of mature oocytes obtained from resected ovaries, some experts suggest performing controlled ovarian stimulation (COS) before surgery and adopting the OTO-COS approach [ 27 – 31 ]. Previous reports stated that the average number of mature oocytes retrieved following oophorectomy in the presence of ovarian tumors with OTO-COS was 11.6 (ranging from 8 to 15 per case) [ 27 – 31 ], whereas for OTO-IVM, it averaged 3.6 (with a range of 3 to 4 per case) [ 7 , 8 , 32 ]. One reason for the higher oocyte retrieval numbers with OTO-COS is that the follicles at the time of retrieval are larger, making it easier to identify the puncture site both visually and with ultrasound guidance [ 28 ].…”

“…In recent years, the practice of cryopreserving embryos, oocytes, and ovarian tissues has attracted attention as effective ways to preserve fertility for female cancer patients, including those with breast cancer, hematologic malignancies, and other forms of cancer [ 1 ]. However, patients with ovarian tumors present specific difficulties because of the anatomic characteristics of these tumors, i.e., the process of ovarian puncture for oocyte retrieval carries the risk of tumor cell dissemination within the abdominal cavity [ 2 ]. Additionally, cryopreservation of ovarian tissue raises concerns about potential neoplastic cell contamination, leading to the possibility of tumor re-implantation in the future [ 3 , 4 ].…”

Serous Borderline Ovarian Tumor Diagnosis, Management and Fertility Preservation in Young Women

“…Hence, ovarian tissue cryopreservation is not recommended in post-pubertal women to this day, but its use in young women may be discussed if the majority of ovarian tissue is removed with a poor outcome of ovarian stimulation. Another emerging FP technique is the ex vivo collection of immature oocytes from ovarian tissue after surgery, followed by in vitro maturation of the follicles, before vitrification [ 46 ]. This technique has been described throughout the case series and case reports, and large-scale studies are lacking to confirm its efficacy.…”

Ovarian stimulation for fertility preservation in a woman with borderline serous ovarian tumor causing a large fluctuating subcutaneous fluid collection: a case report

“…In such cases, ovarian tissue cryopreservation runs the risk of re-introducing the can-cer if the tissue is subsequently returned to the patient. There are over 40 reported cases in the medical literature of ovarian stimulation and oocyte collection in women with ovarian cancer [5][6][7][8][9]. Most of these procedures were performed in women with serous borderline tumors, while some were in women with overt malignancies [9].…”

“…Therefore, fertility preservation in patients who were diagnosed with or previously treated for borderline ovarian tumors is likely reasonable [10]. Whereas ovarian stimulation is usually followed by transvaginal or transabdominal oocyte collection, there are some reports of successful ex-vivo oocyte harvesting in patients with borderline ovarian tumor during the oncologic operation [5,6].…”