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Abstract：
OBJECTIVE: This study aims to report a case of urgent fertility preservation in an oncological patient with collection of immature oocytes in the absence of ovarian stimulation that, through in vitro maturation (IVM), followed by ICSI and cryopreservation of zygotes resulted, 10 years later, in the live birth of a healthy baby.
METHODS: In September 2008, our clinic performed IVM in a 32-year-old woman diagnosed with a ductal invasive carcinoma with positive estradiol receptors, negative progesterone receptors and positive human epidermal growth factor receptor 2. The retrieval of immature oocytes was performed in the absence of ovarian stimulation after a simple mastectomy and prior to any chemotherapy treatment. The compact cumulus-oocyte complexes (COCs) collected were placed in Lag medium for 2 h, followed by incubation in IVM medium, supplemented with heat inactivated patient serum, recombinant FSH, and recombinant LH. After 30 h in culture, cumulus cells were removed, the metaphase II oocytes were microinjected, and the zygotes obtained were cryopreserved. In 2017, the zygotes were thawed and cultured until day 3. One embryo was transferred and the other cryopreserved.
RESULTS: Four compact COCs were collected and subjected to IVM. Two oocytes reached metaphase II and were microinjected. Two zygotes were obtained and were cryopreserved at the two pronuclear stage. Approximately 9 years later, the two zygotes were thawed and cultured until day 3. An embryo with 10 cells was transferred and implanted, resulting in the birth of a healthy baby.
CONCLUSIONS: In cases where urgency to start adjuvant therapy requires immediate oocyte collection, IVM may be the only option to obtain fully competent mature oocytes allowing for effective preservation of the reproductive potential.
METHODS: In September 2008, our clinic performed IVM in a 32-year-old woman diagnosed with a ductal invasive carcinoma with positive estradiol receptors, negative progesterone receptors and positive human epidermal growth factor receptor 2. The retrieval of immature oocytes was performed in the absence of ovarian stimulation after a simple mastectomy and prior to any chemotherapy treatment. The compact cumulus-oocyte complexes (COCs) collected were placed in Lag medium for 2 h, followed by incubation in IVM medium, supplemented with heat inactivated patient serum, recombinant FSH, and recombinant LH. After 30 h in culture, cumulus cells were removed, the metaphase II oocytes were microinjected, and the zygotes obtained were cryopreserved. In 2017, the zygotes were thawed and cultured until day 3. One embryo was transferred and the other cryopreserved.
RESULTS: Four compact COCs were collected and subjected to IVM. Two oocytes reached metaphase II and were microinjected. Two zygotes were obtained and were cryopreserved at the two pronuclear stage. Approximately 9 years later, the two zygotes were thawed and cultured until day 3. An embryo with 10 cells was transferred and implanted, resulting in the birth of a healthy baby.
CONCLUSIONS: In cases where urgency to start adjuvant therapy requires immediate oocyte collection, IVM may be the only option to obtain fully competent mature oocytes allowing for effective preservation of the reproductive potential.
摘要：
目的：本研究旨在报道一例在没有卵巢刺激的情况下收集未成熟卵母细胞的肿瘤患者紧急保留生育力的病例，通过体外成熟（IVM），随后是ICSI和受精卵的冷冻保存，十年后,在一个健康婴儿的活产中。
方法：2008年9月，我们的诊所对一名32岁的女性进行了IVM，该女性被诊断为具有阳性雌二醇受体的导管浸润性癌，孕激素受体阴性和人表皮生长因子受体2阳性。在简单的乳房切除术后和任何化学疗法治疗之前，在没有卵巢刺激的情况下进行未成熟卵母细胞的回收。将收集的致密卵丘-卵母细胞复合物（COCs）置于Lag培养基中2小时，然后在IVM培养基中孵育，补充热灭活的患者血清，重组FSH,和重组LH。培养30小时后，去除卵丘细胞,中期II卵母细胞被显微注射，将获得的受精卵冷冻保存。2017年，将受精卵解冻并培养至第3天。一个胚胎被转移，另一个被冷冻保存。
结果：收集四个紧凑型COC并进行IVM。两个卵母细胞到达中期II并进行显微注射。获得了两个受精卵，并在两个原核阶段冷冻保存。大约9年后,将两个受精卵解冻并培养至第3天。移植并植入了10个细胞的胚胎，导致一个健康的婴儿出生。
结论：在紧急开始辅助治疗需要立即收集卵母细胞的情况下，IVM可能是获得完全合格的成熟卵母细胞的唯一选择，从而可以有效保存生殖潜力。
方法：2008年9月，我们的诊所对一名32岁的女性进行了IVM，该女性被诊断为具有阳性雌二醇受体的导管浸润性癌，孕激素受体阴性和人表皮生长因子受体2阳性。在简单的乳房切除术后和任何化学疗法治疗之前，在没有卵巢刺激的情况下进行未成熟卵母细胞的回收。将收集的致密卵丘-卵母细胞复合物（COCs）置于Lag培养基中2小时，然后在IVM培养基中孵育，补充热灭活的患者血清，重组FSH,和重组LH。培养30小时后，去除卵丘细胞,中期II卵母细胞被显微注射，将获得的受精卵冷冻保存。2017年，将受精卵解冻并培养至第3天。一个胚胎被转移，另一个被冷冻保存。
结果：收集四个紧凑型COC并进行IVM。两个卵母细胞到达中期II并进行显微注射。获得了两个受精卵，并在两个原核阶段冷冻保存。大约9年后,将两个受精卵解冻并培养至第3天。移植并植入了10个细胞的胚胎，导致一个健康的婴儿出生。
结论：在紧急开始辅助治疗需要立即收集卵母细胞的情况下，IVM可能是获得完全合格的成熟卵母细胞的唯一选择，从而可以有效保存生殖潜力。
