Fertility Preservation in Adolescence and Young Women with Huge Ovarian Tumors - Israeli Fertility Association Conference-Ayala 2017, May 8-9, 2017

Yariv Shlomo Gidoni ¹ Noam Smorgik ² Ester Kasterstein Esti Kasterstein ¹ Orna Bern ¹ Orna Bern Jonathan Barkat ¹ Billa Maslansky ¹ Dafna Komarovsky ¹ Deborah Strassburger ¹ Danielle Dukan ¹ Ido Ben-Ami ¹ Orit Lemberberg ¹ David Schneider ² Ariel Revel ¹ Refael Ron-El ¹ Zvi Vaknin ²

¹IVF and Infertility unit, Assaf Harofeh Medical Center, Sackler Faculty of Medicine,Tel Aviv University
²Gynecology department, Assaf Harofeh Medical Center,Sackler Faculty of Medicine, Tel Aviv University

Introduction: Surgical treatment of huge ovarian cysts (>15 cm) suspicious for malignancy in young women typically requires removal of the involved ovary, with possible implications on future fertility. Management of huge tumors presents a challenge to the gynecologic oncologist and fertility specialist.

Aim: To describe a multidisciplinary algorithm based approach for treatment and fertility preservation in adolescents and young women with huge ovarian tumors.

Materials &Methods: We developed an algorithm considering clinical and imaging evaluation (>15 cm≤), suspicious for malignancy (ROMA) and fertility concerns. Two young patients were operated for huge ovarian tumors reaching the xiphoid, and highly suspicious for malignancy. Using the offered algorithm, laparotomy was performed with conservative gyneco-oncologic approach combined with advanced fertility preservation procedures.

Results: Two young patients (17 and 21 years old) underwent explorative laparotomy with unilateral oophorectomy and contralateral oocyte retrieval, yielding one immature oocyte which did not mature in vitro in the first patient, and four immature oocytes from which one metaphase II oocyte was cryopreserved by vitrification in the second patient. In both cases, following oophorectomy, large pieces of ovarian cortex tissue were collected for cryopreservation and the remainder of the ovary was sending for pathology. At the IVF laboratory, the samples of ovarian cortex were processed into 10×8 mm slices (100 slices and 60 slices, respectively) that were cryopreserved. The final pathology revealed complex mature teratoma in the first case and a primitive neuroectodermal tumor in the second patient. The latter patient then underwent a random start IVF cycle, cryopreservation of 13 mature oocytes before starting chemotherapy.

Conclusions: Ovarian tissue cryopreservation with oocyte freezing can be offered to patients as an optional fertility preservation treatment in young women presenting with suspicious ovarian tumors requiring urgent surgical intervention. In cases of malignancy, the ovarian tissue may be preserved until the technology of an artificial ovary is available.