Ovarian stimulation and embryo banking for fertility preservation in a woman with severe mixed connective tissue disease: is it safe?

Abstract

Objective To report the first case of using assisted reproductive technologies (ART) for fertility preservation in a patient with mixed connective tissue disease (MCTD), secondary pulmonary hypertension (PH) and antiphospholipid syndrome (APS). Design Case-report and review of the literature. Setting Academic infertility practice and tertiary care center. Patient(s) A 25-year-old woman with MCTD, complicated with PH and APS, who was scheduled for gonadotoxic therapy Intervention(s) Controlled ovarian hyperstimulation, egg retrieval, embryo banking. Main outcome measure(s) Successful ART cycle leading to embryo banking without worsening her underlying disease. Result(s) Following successful embryo cryopreservation, the patient experienced respiratory failure and other severe complications, resulting in a prolonged hospital stay. Conclusion(s) Controlled ovarian hyperstimulation for embryo banking in women with MCTD, PH and APS may pose a risk for potentially catastrophic complications. A multidisciplinary approach to these patients is necessary to optimize the outcomes of such procedures. More data are needed regarding the safety of fertility preservation technologies in patients with complex medical diseases.

Challenges of fertility preservation in non‐oncological diseases

“…Severe complications were reported in a 25‐year‐old woman with an acute phase of mixed connective tissue disease. After an oocyte cryopreservation procedure for fertility preservation, she presented with a cascade of multiorgan system dysfunctions probably exacerbated by increased estradiol levels and the sedation required for oocyte retrieval . Hence, the risk of multiorgan complications can be life‐threatening in patients in the acute phase of the disease.…”

“…After an oocyte cryopreservation procedure for fertility preservation, she presented with a cascade of multiorgan system dysfunctions probably exacerbated by increased estradiol levels and the sedation required for oocyte retrieval. 42 Hence, the risk of multiorgan complications can be life-threatening in patients in the acute phase of the disease. To avoid these risks, some authors have suggested collecting immature oocytes during a natural menstrual cycle, followed by in vitro maturation and vitrification.…”

Unnecessary life threatening complications after IVF in mixed connective tissue disease

“…I have read with great interest the recent demonstrative case report by Sioulas & Gracia on ovarian stimulation and embryo banking for fertility preservation in a woman with severe mixed connective tissue disease [MCTD] [1], and congratulate the authors for their integrity and self criticism. The authors correctly emphasize the life threatening complications associated with pulmonary hypertension and IVF in MCTD, as dramatically demonstrated by their case report.…”

“…Therefore this treatment should be considered and recommended to every young woman before gonadotoxic chemotherapy. The authors [1] mention the possibility "…that GnRH may exacerbate autoimmune diseases, an association that merits further research ". The answer to their raised question has been supplied by others and by us [2,4,5].…”