Pregnancy, Live Birth Resulting From Cryopreserved Embryos
Pregnancy, Live Birth Resulting From Cryopreserved Embryos
Borderline ovarian tumours typically occur in younger women, who tend to present in early stages of the disease. In particular, for early stage tumours, fertility sparing surgery has been proposed, although recurrence and malignancy may still recur (Cadron et al., 2007). In these cases, because of high rates of recurrence of up to 45% with conservative surgery, such as a cystectomy (Cadron et al., 2007), the generation of oocytes for vitrification or embryo generation is now becoming an option for fertility preservation (Huang et al., 2007; Fatemi et al., 2011).
In this case, the final histology included foci of well-differentiated micro-papillary serious carcinoma in the largely borderline serous tumour. Despite adjuvant chemotherapy, she had a recurrence involving her other ovary, necessitating its removal. The option for fertility preservation in this context was thus limited to obtaining oocytes for either cryopreservation through vitrification or the generation of embryos, as ovarian tissue cryopreservation has a theoretical risk of re-implantation of the cancer or multi-foci neo-carcinogenesis in the remaining tissues (Cadron et al., 2007).
To date, there are five other reports on the ex vivo harvest of oocytes in the context of borderline ovarian tumours. Revel et al. (2004) reported a similar approach as ours in an endometrial cancer patient. However, embryo transfer was not done as the patient had to look for surrogacy as she also had hysterectomy. Another approach involved the use of IVM of immature oocytes harvested at the time of oophorectomy and vitrification of resulting oocytes (Huang et al., 2007). A different approach utilized controlled hyperstimulation of the ovaries, and retrieval of mature oocytes at oophorectomy either through laparotomy (Fatemi et al., 2011) or laparoscopy (Bocca et al., 2011), with subsequent vitrification of the oocytes. Similar to Huang et al., Fadini et al. (2012) cryopreserved oocytes after IVM then performed ICSI and transferred two resulting embryos in a patient with ovarian adenocarcinoma. However, this did not result in a pregnancy. To our knowledge, this case reported here is the first successful pregnancy and live birth reported, from the transfer of frozen–thawed embryos derived from ex vivo harvested oocytes, after IVM and ICSI, thus validating this important approach in fertility preservation in suitable candidates, ovarian cancer patients in particular. Our approach is feasible only when the patient has a partner at the time of surgery.
Discussion
Borderline ovarian tumours typically occur in younger women, who tend to present in early stages of the disease. In particular, for early stage tumours, fertility sparing surgery has been proposed, although recurrence and malignancy may still recur (Cadron et al., 2007). In these cases, because of high rates of recurrence of up to 45% with conservative surgery, such as a cystectomy (Cadron et al., 2007), the generation of oocytes for vitrification or embryo generation is now becoming an option for fertility preservation (Huang et al., 2007; Fatemi et al., 2011).
In this case, the final histology included foci of well-differentiated micro-papillary serious carcinoma in the largely borderline serous tumour. Despite adjuvant chemotherapy, she had a recurrence involving her other ovary, necessitating its removal. The option for fertility preservation in this context was thus limited to obtaining oocytes for either cryopreservation through vitrification or the generation of embryos, as ovarian tissue cryopreservation has a theoretical risk of re-implantation of the cancer or multi-foci neo-carcinogenesis in the remaining tissues (Cadron et al., 2007).
To date, there are five other reports on the ex vivo harvest of oocytes in the context of borderline ovarian tumours. Revel et al. (2004) reported a similar approach as ours in an endometrial cancer patient. However, embryo transfer was not done as the patient had to look for surrogacy as she also had hysterectomy. Another approach involved the use of IVM of immature oocytes harvested at the time of oophorectomy and vitrification of resulting oocytes (Huang et al., 2007). A different approach utilized controlled hyperstimulation of the ovaries, and retrieval of mature oocytes at oophorectomy either through laparotomy (Fatemi et al., 2011) or laparoscopy (Bocca et al., 2011), with subsequent vitrification of the oocytes. Similar to Huang et al., Fadini et al. (2012) cryopreserved oocytes after IVM then performed ICSI and transferred two resulting embryos in a patient with ovarian adenocarcinoma. However, this did not result in a pregnancy. To our knowledge, this case reported here is the first successful pregnancy and live birth reported, from the transfer of frozen–thawed embryos derived from ex vivo harvested oocytes, after IVM and ICSI, thus validating this important approach in fertility preservation in suitable candidates, ovarian cancer patients in particular. Our approach is feasible only when the patient has a partner at the time of surgery.
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