Ultrasound-guided Ex-vivo Retrieval of Mature Oocytes for Fertility Preservation During Laparoscopic Oophorectomy: A Case Report

De La Blanca, Enrique; Fernandez-Perez, Maria; Martin-Diaz, Elena; Lozano, Manuel; Garcia-Sanchez, Marta; Monedero, Carolina

Ultrasound-guided Ex-vivo Retrieval of Mature Oocytes for Fertility Preservation During Laparoscopic Oophorectomy: A Case Report

Authors

Enrique de la Blanca ¹

Maria Fernandez-Perez ¹

Elena Martin-Diaz ¹

Manuel Lozano ²

Marta Garcia-Sanchez ¹

Carolina Monedero ¹

¹ Department of Assisted Reproduction, Hospital Quironsalud Malaga, Malaga, Spain

² Department of Gynecology, Hospital Quironsalud Malaga, Malaga, Spain

Abstract

Background: Cryopreservation of oocytes is an efficient method of fertility preservation (FP) that can be applied in women suffering from gynecologic conditions that menace their reproductive future. Collection of oocytes becomes challenging in some scenarios, like the possibility of an ovarian cancer, the "ex-vivo" harvest of oocytes for FP, aspirating follicles directly from the ovarian specimen already excised by laparotomy or laparoscopy and it is an option for these cases. Case Presentation: In the present case report, the case of a patient with an adnexal mass suspected to be a recurrent teratoma was described who referred to our Assisted Reproduction Unit in Hospital Quironsalud Malaga for FP counseling. After controlled ovarian hyperstimulation, followed by laparoscopic abdominal examination and oophorectomy, an ex-vivo follicular aspiration for oocyte retrieval was performed on the specimen, using a standard ultrasound-guided procedure to ease and improve the process. All the follicles were aspirated and 5 metaphase II oocytes were obtained. Conclusion: This is to our knowledge, the first communication describing the ex-vivo ovarian aspiration of mature oocytes for FP using standard ultrasound guidance. Although this ultrasound guidance is not completely necessary, as other authors demonstrated previously, such a procedure permitted an easy and complete harvest of oocytes in a rare tumor with bizarre cystic formations, which made follicle recognition very difficult.

Keywords

vivo oocyte retrieval

Cryopreservation

Fertility preservation

Laparascopy

ovarian neoplasms

Ovarian teratoma

Struma ovarii

Vitrification

American College of Obstetricians and Gynecologists. ACOG practice bulletin. management of adnexal masses. Obstet Gynecol. 2007;110(1):201-14.

Royal College of Obstetricians and Gynaecologists (RCOG). Management of Suspected Ovarian Masses in Premenopausal Women. London: Royal College of obstetrician and gynaecologists (RCOG); 2011 Nov. 14 p. Green Top Guidelines No. 62.

Dadoun Y, Azaïs H, Keller L, d´Oracio E, Collinet P, Decanter C. [Systematic proposal of fertility preservation by mature oocyte cryopreservation for recurrent benign ovarian tumors]. Gynecol Obstet Fertil Senol. 2017;45(6):356-65. French.

Prasath EB, Chan ML, Wong WH, Lim CJ, Tharmalingam MD, Hendricks M, et al. First pregnancy and live birth resulting from cryopreserved embryos obtained from in vitro matured oocytes after oophorectomy in an ovarian cancer patient. Hum Reprod. 2014;29(2):276-8.

Alvarez M, Sole M, Devesa M, Fabregas R, Boada M, Tur R, et al. Live birth using vitrified--warmed oocytes in invasive ovarian cancer: case report and literature review. Reprod Biomed Online. 2014;28(6):663-8.

Sinha A, Ewies AA. Ovarian mature cystic teratoma: Challenges of surgical management. Obstet Gynecol Int. 2016;2016:2390178.

Wang W, Lai YC. Evidence of metachronous development of ovarian teratomas: a case report of bilateral mature cystic teratomas of the ovaries and systematic literature review. J Ovarian Res. 2017;10(1):17.

Park SB, Kim JK, Kim KR, Cho KS. Imaging findings of complications and unusual manifestations of ovarian teratomas. Radiographics. 2008;28(4):969-83.

Fatemi HM, Kyrou D, Al-Azemi M, Stoop D, De Sutter P, Bourgain C, et al. Ex-vivo oocyte retrieval for fertility preservation. Fertil Steril. 2011;95(5):1787.e15-7.

Revel A, Safran A, Benshushan A, Shushan A, Laufer N, Simon A. In vitro maturation and fertilization of oocytes from an intact ovary of a surgically treated patient with endometrial carcinoma: Case report. Hum Reprod. 2004;19(7):1608-11.

Huang JY, Buckett WM, Gilbert L, Tan SL, Chian RC. Retrieval of immature oocytes followed by in vitro maturation and vitrification: a case report on a new strategy of fertility preservation in women with borderline ovarian malignancy. Gynecol Oncol. 2007;105(2):542-4.

Bocca S, Dedmond D, Jones E, Stadtmauer L, Oehninger S. Successful extracorporeal mature oocyte harvesting after laparoscopic oophorectomy following controlled ovarian hyperstimulation for the purpose of fertility preservation in a patient with borderline ovarian tumor. J Assist Reprod Genet. 2011;28(9):771-2.

Kuwayama M, Vajta G, Kato O, Leibo SP. Highly efficient vitrification method for cryopreservation of human oocytes. Reprod Biomed Online. 2005;11(3):300-8.

Savelli L, Testa AC, Timmerman D, Paladini D, Ljungberg O, Valentin L. Imaging of gynecological disease (4): clinical and ultrasound characteristics of struma ovarii. Ultrasound Obstet Gynecol. 2008;32(2):210-9.

Matsushita H, Tani H. Successful infertility treatment following fertility-sparing surgery and chemotherapy for ovarian immature teratoma: a case report and a literature review. Reprod Med Biol. 2011;10(3):193-8.

Oliveira FG, Dozortsev D, Diamond MP, Fracasso A, Abdelmassih S, Abdelmassih V, et al. Evidence of parthenogenetic origin of ovarian teratoma: case report. Hum Reprod. 2004;19(8):1867-70.

Caspi B, Weissman A, Zalel Y, Barash A, Tulandi T, Shoham Z. Ovarian stimulation and in vitro fertilization in women with mature cystic teratomas. Obstet Gynecol. 1998;92(6):979-81.

Segers I, Mateizel I, Van Moer E, Smitz J, Tournaye H, Verheyen G, et al. In vitro maturation (IVM) of oocytes recovered from ovariectomy specimens in the laboratory: a promising ‘ex vivo’ method of oocyte cryopreservation resulting in the first report of an ongoing pregnancy in Europe. J Assist Reprod Genet. 2015;32(8):1221-31.

Gremeau AS, Andreadis N, Fatum M, Craig J, Turner K, McVeigh E, et al. In vitro maturation or in vitro fertilization for women with polycystic ovaries? a case-control study of 194 treatment cycles. Fertil Steril. 2012;98(2):355-60.

Shirasawa H, Terada Y. In vitro maturation of human immature oocytes for fertility preservation and research material. Reprod Med Biol. 2017;16(3):258-67.

Darai E, Fauvet R, Uzan C, Gouy S, Duvillard P, Morice P. Fertility and borderline ovarian tumor: a systematic review of conservative management, risk of recurrence and alternative options. Hum Reprod Update. 2013;19(2):151-66.

Whyte JS, Hawkins E, Rausch M, Hershlag A. In vivo oocyte retrieval in a young woman with ovarian cancer. Obstet Gynecol. 2014;124(2 Pt 2 Suppl 1):484-6.

Nielsen AP, Korsholm AS, Lemmen J, Sylvest R, Sopa N, Andersen AN. Selective use of corifollitropin for controlled ovarian stimulation for IVF in patients with low anti-Müllerian hormone. Gynecol Endocrinol. 2016;32(8);625-8.

Sztein JM, O’Brien MJ, Farley JS, Mobraaten LE, Eppig JJ. Rescue of oocytes from antral follicles of cryopreserved mouse ovaries: competence to undergo maturation, embryogenesis, and development to term. Hum Reprod. 2000;15(3):567-71.

De Sutter P, Dozortsev D, Verhoeff A, Coetsier T, Jansen CA, Van Os HC, et al. Transport intracytoplasmic sperm injection (ICSI): a cost-effective alternative. J Assist Reprod Genet. 1996;13(3):234-7.

Pereira N, Hubschmann AG, Lekovich JP, Schattman GL, Rosenwaks Z. Ex vivo retrieval and cryopreservation of oocytes from oophorectomized specimens for fertility preservation in a BRCA1 mutation carrier with ovarian cancer. Fertil Steril. 2017;108(2):357-60.

Doyle JO, Richter KS, Lim J, Stillman RJ, Graham JR, Tucker MJ. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertil Steril. 2016;105(2):459-66.e2.