Gestational surrogacy after intra-operative oocyte collection in a hysterectomised woman diagnosed with endometrial cancer

Abstract

Please cite this paper as: Lavery S, Ng C, Kyrgiou M, Farthing A. Gestational surrogacy after intra-operative oocyte collection in a hysterectomised woman diagnosed with endometrial cancer. BJOG 2011;118:1669-1671 We report an unusual case of gestational surrogacy following mature egg collection at laparotomy and from subsequent oophorectomy specimens in a hysterectomised woman with stage 3b endometrial carcinoma. The commissioning couple was initially referred from a district general hospital to our recurrent miscarriage clinic for further investigation of recurrent first-trimester miscarriages. A diagnostic hysteroscopy with endometrial sampling was carried out to rule out possible uterine abnormalities and the histology revealed the presence of complex atypical hyperplasia. The woman was subsequently referred to our tertiary gynaecological cancer centre for specialist advice and treatment. Two 3-month courses of high-dose progestogen were initiated, which successfully reversed the dysplastic process as a subsequent repeat hysteroscopy and endometrial biopsy were reported as normal. Given the high risk of recurrent complex atypical hyperplasia, the woman was advised that pregnancy should be achieved within a reasonable time interval. In view of the woman's age (38 years) and failure to conceive over the following six spontaneous cycles, her general practitioner advised and referred the couple for assisted conception. During that period and before receiving any fertility treatment the woman developed irregular vaginal spotting with postcoital and intermenstrual bleeding. A repeat ultrasound scan showed endometrial thickness of 14 mm. A decision was made to perform a repeat hysteroscopy and endometrial biopsy before fertility treatment, which diagnosed the presence of an invasive endometrioid adenocarcinoma of the endometrium with no lymphovascular space invasion. Following discussion at the oncology multidisciplinary team meeting and given the woman's wishes to preserve her reproductive potential, a hysterectomy with ovarian conservation was advised. An uncomplicated total laparoscopic hysterectomy was performed. Histopathology confirmed the presence of a grade 2 endometrioid endometrial tumour involving the endometrium with no myometrial invasion. A nodule on the uterosacral ligament that was also excised intraoperatively, turned out to be an adenomyoma with a further area of tumour within its centre. As confirmed disease outside the uterus significantly affects prognosis, the oncology multidisciplinary team staged the tumour as equivalent to 3b (International Federation of Obstetrics and Gynecology; FIGO) carcinoma of the endometrium and advised bilateral salpingo-oophorectomy and adjuvant pelvic radiotherapy.In view of the woman's strong wishes to have a chance of having her own genetic offspring, agreement was made to run an ovarian stimulatory cycle before proceeding to oophorectomy with the eventual intention of pregnancy via gestational surrogacy. Given the stage of the tumour, concerns were raised as to...

Fertility preservation in women with cervical, endometrial or ovarian cancers

“…A proportion of women treated for cancer might achieve pregnancy by surrogacy agreement, which is the carrying of a pregnancy by a third party (surrogate), a procedure that is allowed in some countries. Surrogacy gives the possibility of having biologically related children if gametes have been previously cryopreserved [ 76 , 78 ].…”

In vitro maturation and cryopreservation of oocytes retrieved from intra-operative aspiration during second enucleation for ovarian tumor: A case report

“…There are several reports concerning oocyte retrieval from resected ovaries and the outcomes of IVM in patients with various malignancies, such as breast cancer, endometrial carcinoma, and cervical cancer (Walls et al, 2015, Lavery et al, 2011, Takae et al, 2015). On the other hand, few studies have reported the intra-operative retrieval of immature oocytes in vivo from stimulated ovaries (Kim et al, 2015).…”