Introduction: The progressions in cancer therapy faces an increasing number of surviving women to endure the long term consequences of chemotherapy and seeking fertility preservation options. Currently, embryo and oocyte cryopreservation appear to provide the best fertility preservation option. For women who have been diagnosed with advanced stage of cancer and may not have sufficient time to undergo ovarian stimulation prior to chemotherapy or ovarian stimulation is contraindicated, in vitro maturation (IVM) is an effective treatment and can be done in any phase of the menstruation cycle.
Aim: To report a successful novel approach for fertility preservation by double immature oocyte retrieval at the luteal phase, in vitro maturation and embryo cryopreservation.
Materials & Methods: A 33 year old woman, married and a mother to one child, newly diagnosed with breast cancer, was seeking for fertility preservation prior to chemotherapy. She was first seen at our clinic on day 17 of her regular menstrual cycle and supposed to undergo gonadotoxic treatment within two weeks. An urgent egg retrieval of immature oocytes was offered to her with IVM and vitrification of the zygotes.
Results: Immature oocyte retrieval was performed in the luteal phase (day 21) due to restricted time table. Five immature oocytes were recovered. After 24h IVM three metaphase II (M-II) oocytes were injected by ICSI procedure with husband's sperm and 3 zygotes (2PN) were vitrified. Three days after the first oocyte retrieval we scanned her ovaries and identified few more follicles. A second retrieval was done on day 30 of her menstrual cycle. Four immature oocytes were recovered. After IVM additional three metaphase II (M-II) oocytes were injected by ICSI procedure with her husband sperm cell and 3 more zygotes were vitrified. Two years after completing her chemotherapy treatment her oncologist permitted her to conceive. The couple turned back to our clinic after one more year of infertility (3 years after completing the treatment) asking to replace her vitrified embryos. Three embryos were warmed, cultured. Two of them survived and have been transferred to her uterus. Intrauterine pregnancy was diagnosed with a viable fetus. The patient is on her 9th gestational week.
Conclusions: IVM of immature oocytes retrieved during the luteal phase is feasible, especially as urgent fertility preservation is needed. We present the worldwide first
