Oncofertility case report: live birth 10 years after oocyte in vitro maturation and zygote cryopreservation

Abstract

Purpose This study aims to report a case of urgent fertility preservation in an oncological patient with collection of immature oocytes in the absence of ovarian stimulation that, through in vitro maturation (IVM), followed by ICSI and cryopreservation of zygotes resulted, 10 years later, in the live birth of a healthy baby. Methods In September 2008, our clinic performed IVM in a 32-year-old woman diagnosed with a ductal invasive carcinoma with positive estradiol receptors, negative progesterone receptors and positive human epidermal growth factor receptor 2. The retrieval of immature oocytes was performed in the absence of ovarian stimulation after a simple mastectomy and prior to any chemotherapy treatment. The compact cumulus-oocyte complexes (COCs) collected were placed in Lag medium for 2 h, followed by incubation in IVM medium, supplemented with heat inactivated patient serum, recombinant FSH, and recombinant LH. After 30 h in culture, cumulus cells were removed, the metaphase II oocytes were microinjected, and the zygotes obtained were cryopreserved. In 2017, the zygotes were thawed and cultured until day 3. One embryo was transferred and the other cryopreserved. Results Four compact COCs were collected and subjected to IVM. Two oocytes reached metaphase II and were microinjected. Two zygotes were obtained and were cryopreserved at the two pronuclear stage. Approximately 9 years later, the two zygotes were thawed and cultured until day 3. An embryo with 10 cells was transferred and implanted, resulting in the birth of a healthy baby. Conclusions In cases where urgency to start adjuvant therapy requires immediate oocyte collection, IVM may be the only option to obtain fully competent mature oocytes allowing for effective preservation of the reproductive potential.

Optical coherence microscopy allows for quality assessment of immature mouse oocytes

“…Around 25% of women before the age of 30 undergoing chemotherapeutic cancer treatments develop acute ovarian failure or premature menopause (Letourneau et al, 2012). Cryopreservation of ovarian follicles before the oncological treatment, followed by IVM of oocytes before fertilization, helps to prevent infertility in cancer patients (Chang et al, 2014;Dudani and Gupta, 2014;Sauerbrun-Cutler et al, 2015;Rodrigues et al, 2020). A similar approach is increasingly often applied for women with polycystic ovary syndrome to avoid the risk of ovarian hyperstimulation syndrome or overcome poor ovarian response to hormonal stimulation (Walls et al, 2014;Fatum et al, 2020).…”

“…In vitro fertilization (IVF) has become one of the most important procedures for treating infertility in humans and for breeding livestock. IVF is more and more often accompanied by in vitro maturation (IVM) of oocytes, e.g., in the case of oncofertility treatment, patients with polycystic ovary syndrome, or in assisted reproduction of farm animals (Byrd et al, 1997;Nagai, 2001;Chang et al, 2014;Dudani and Gupta, 2014;Galli et al, 2014;Walls et al, 2014;Sauerbrun-Cutler et al, 2015;Fatum et al, 2020;Rodrigues et al, 2020;De Vos et al, 2021).…”

In vitro maturation of oocytes as a laboratory approach to polycystic ovarian syndrome (PCOS): From oocyte to embryo

“…IVM media is tissue culture media supplemented with proteins, and may also include patient's heat inactivated own serum, and hormones FSH and LH. Hormonal levels may vary from clinic to clinic, but generally they are used at a concentration of 1 UI/μl (Rodrigues et al, 2020; Yang et al, 2021). IVM culture time is generally set at 30 h, as it has been shown that longer time may be detrimental to the oocyte (Vuong et al, 2020; Yang et al, 2021).…”

Effect of endometrial cell-conditioned medium and platelet-rich plasma on the developmental competence of mouse preantral follicles: An in vitro study

“…Fertility preservation strategies, which involve cryopreservation of the oocyte and embryo, can help achieve successful pregnancy; however, some obstacles exist. For example, these methods require time to stimulate ovulation, delaying the therapeutic process for patients with cancer [1]. Furthermore, substantial concerns exist regarding cancer recurrence after ovarian tissue cryopreservation and autotransplantation due to the possibility of malignant cell contamination [2][3][4].…”