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Is in vitro maturation of oocytes retrieved ex vivo from ovarian tissue an effective fertility preservation technique in the presence of organic ovarian cysts?

  • Mona Bourg
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
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  • Jessika Moreau
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France

    TOXALIM, EXPER group, Toulouse National Vetenary School, 23, chemin des Capelles, 31076 Toulouse cedex 3, France
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  • Manon Carles
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
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  • Florence Cadoret
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
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  • Florence Lesourd
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
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  • Anna Tournier
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
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  • Roger D Léandri
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France

    TOXALIM, EXPER group, Toulouse National Vetenary School, 23, chemin des Capelles, 31076 Toulouse cedex 3, France
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  • Nicolas Gatimel
    Correspondence
    Corresponding author at: Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France.
    Affiliations
    Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France

    DEFE (Développement Embryonnaire, Fertilité et Environnement), UMR1203 Université Toulouse et Montpellier, INSERM, Toulouse Teaching Hospital Group, 330 avenue de Grande Bretagne, 31059 Toulouse, France
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Published:December 26, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.12.025

      Abstract

      Objective(s)

      In vitro maturation (IVM) of oocytes retrieved ex vivo from ovarian tissue (OTO-IVM) could be an additional source of mature oocytes with the potential to optimise medical fertility preservation (FP) after oophorectomy. It is often undertaken at the same time as the ovarian tissue cryopreservation (OTC). In the presence of an organic ovarian cyst, OTO-IVM could prove to be the only technique available to permit FP since ovarian stimulation, transvaginal ovarian needle puncture or future ovarian tissue graft are contraindicated. However, the presence of an organic cyst could alter follicular growth and the number of retrievd oocytes. Our study aims to assess the efficiency of OTO-IVM in such situations.

      Study design

      Retrospective, observational study involving 20 female patients with FP by OTO-IVM between May 2017 and November 2021 at the University Hospital of Toulouse. Oocytes retrieved “ex vivo” were transferred to an IVM medium with HP-hMG, LH and HSA and then vitrified after 24 to 48 h of IVM. Data analysis was performed on the total population and comparatively between patients who had or did not have an organic ovarian cyst.

      Results

      The indications included 15 oncologic and 5 non-oncologic indications. Ten had an organic ovarian cyst on the retrieved ovary. The number of retrieved oocytes was 17.4+/−12.0 in the absence of cyst vs 4.1+/−6.3 in the presence (p = 0.003). The number of vitrified mature oocytes was 5.8+/−5.3 in the absence vs 1.1+/−2.2 (median = 0) in the presence of a cyst (p = 0.03). Ninety percent of the patients with an organic cyst had less than two vitrified mature oocytes. The mean maturation rate was 34%, not significantly different between the two groups. We found a correlation between serum AMH level and the number of mature oocytes: ρ: 0.47 CI95 = [0.02; 0.76]; p = 0.04.

      Conclusion(s)

      OTO-IVM is an additional source of mature oocytes to optimise FP after oophorectomy. However, in the presence of an organic ovarian cyst on the retrieved ovary, the exocrine, paracrine and endocrine functions of the ovary are impaired. As such, the number of immature oocytes obtained is highly impacted and appears to be insufficient to be able to propose systematically this technique in such situations.

      Keywords

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      References

        • 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: 1221-1231
        • Fasano G.
        • Moffa F.
        • Dechene J.
        • Englert Y.
        • Demeestere I.
        Vitrification of in vitro matured oocytes collected from antral follicles at the time of ovarian tissue cryopreservation.
        Reprod Biol Endocrinol. 2011; 9: 150
        • Segers I.
        • Bardhi E.
        • Mateizel I.
        • Van Moer E.
        • Schots R.
        • Verheyen G.
        • et al.
        Live births following fertility preservation using in-vitro maturation of ovarian tissue oocytes.
        Hum Reprod. 2020; 35: 2026-2036
        • Yin H.
        • Jiang H.
        • Kristensen S.G.
        • Andersen C.Y.
        Vitrification of in vitro matured oocytes collected from surplus ovarian medulla tissue resulting from fertility preservation of ovarian cortex tissue.
        J Assist Reprod Genet. 2016; 33: 741-746
        • Nikiforov D.
        • Junping C.
        • Cadenas J.
        • Shukla V.
        • Blanshard R.
        • Pors S.E.
        • et al.
        Improving the maturation rate of human oocytes collected ex vivo during the cryopreservation of ovarian tissue.
        J Assist Reprod Genet. 2020; 37: 891-904
        • Revel A.
        • Revel-Vilk S.
        • Aizenman E.
        • Porat-Katz A.
        • Safran A.
        • Ben-Meir A.
        • et al.
        At what age can human oocytes be obtained?.
        Fertil Steril. 2009; 92: 458-463
        • Preservation EGGoFF
        • Anderson R.A.
        • Amant F.
        • Braat D.
        • D'Angelo A.
        • de Sousa Chuva
        • Lopes S.M.
        • et al.
        ESHRE guideline: female fertility preservation.
        Hum Reprod Open. 2020; (hoaa052)
        • Prasath E.B.
        • Chan M.L.
        • Wong W.H.
        • Lim C.J.
        • Tharmalingam M.D.
        • 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: 276-278
        • Uzelac P.S.
        • Delaney A.A.
        • Christensen G.L.
        • Bohler H.C.
        • Nakajima S.T.
        Live birth following in vitro maturation of oocytes retrieved from extracorporeal ovarian tissue aspiration and embryo cryopreservation for 5 years.
        Fertil Steril. 2015; 104: 1258-1260
        • Gatimel N.
        • Moreau J.
        • Bettiol C.
        • Parinaud J.
        • Leandri R.D.
        Semi-automated versus manual embryo vitrification: inter-operator variability, time-saving, and clinical outcomes.
        J Assist Reprod Genet. 2021; 38: 3213-3222
        • Lierman S.
        • Tolpe A.
        • De Croo I.
        • De Gheselle S.
        • Defreyne J.
        • Baetens M.
        • et al.
        Low feasibility of in vitro matured oocytes originating from cumulus complexes found during ovarian tissue preparation at the moment of gender confirmation surgery and during testosterone treatment for fertility preservation in transgender men.
        Fertil Steril. 2021; 116: 1068-1076
        • Cobo A.
        • Garcia-Velasco J.
        • Domingo J.
        • Pellicer A.
        • Remohi J.
        Elective and Onco-fertility preservation: factors related to IVF outcomes.
        Hum Reprod. 2018; 33: 2222-2231
        • Park C.W.
        • Lee S.H.
        • Yang K.M.
        • Lee I.H.
        • Lim K.T.
        • Lee K.H.
        • et al.
        Cryopreservation of in vitro matured oocytes after ex vivo oocyte retrieval from gynecologic cancer patients undergoing radical surgery.
        Clin Exp Reprod Med. 2016; 43: 119-125
        • Schubert B.
        • Canis M.
        • Darcha C.
        • Artonne C.
        • Pouly J.L.
        • Dechelotte P.
        • et al.
        Human ovarian tissue from cortex surrounding benign cysts: a model to study ovarian tissue cryopreservation.
        Hum Reprod. 2005; 20: 1786-1792
        • Hourvitz A.
        • Yerushalmi G.M.
        • Maman E.
        • Raanani H.
        • Elizur S.
        • Brengauz M.
        • et al.
        Combination of ovarian tissue harvesting and immature oocyte collection for fertility preservation increases preservation yield.
        Reprod Biomed Online. 2015; 31: 497-505
        • Kedem A.
        • Yerushalmi G.M.
        • Brengauz M.
        • Raanani H.
        • Orvieto R.
        • Hourvitz A.
        • et al.
        Outcome of immature oocytes collection of 119 cancer patients during ovarian tissue harvesting for fertility preservation.
        J Assist Reprod Genet. 2018; 35: 851-856
        • Dietrich J.E.
        • Jauckus J.
        • Hoffmann S.
        • Liebenthron J.
        • Capp E.
        • Strowitzki T.
        • et al.
        In vitro maturation of immature oocytes from ovarian tissue prior to shipment to a cryobank.
        Arch Gynecol Obstet. 2020; 302: 1019-1024
        • Maman E.
        • Meirow D.
        • Brengauz M.
        • Raanani H.
        • Dor J.
        • Hourvitz A.
        Luteal phase oocyte retrieval and in vitro maturation is an optional procedure for urgent fertility preservation.
        Fertil Steril. 2011; 95: 64-67
        • Grynberg M.
        • Poulain M.
        • le Parco S.
        • Sifer C.
        • Fanchin R.
        • Frydman N.
        Similar in vitro maturation rates of oocytes retrieved during the follicular or luteal phase offer flexible options for urgent fertility preservation in breast cancer patients.
        Hum Reprod. 2016; 31: 623-629
        • Gilchrist R.B.
        • Luciano A.M.
        • Richani D.
        • Zeng H.T.
        • Wang X.
        • Vos M.D.
        • et al.
        Oocyte maturation and quality: role of cyclic nucleotides.
        Reproduction. 2016; 152: R143-R157
        • Sanchez F.
        • Lolicato F.
        • Romero S.
        • De Vos M.
        • Van Ranst H.
        • Verheyen G.
        • et al.
        An improved IVM method for cumulus-oocyte complexes from small follicles in polycystic ovary syndrome patients enhances oocyte competence and embryo yield.
        Hum Reprod. 2017; 32: 2056-2068
        • Kirillova A.
        • Bunyaeva E.
        • Van Ranst H.
        • Khabas G.
        • Farmakovskaya M.
        • Kamaletdinov N.
        • et al.
        Improved maturation competence of ovarian tissue oocytes using a biphasic in vitro maturation system for patients with gynecological malignancy: a study on sibling oocytes.
        J Assist Reprod Genet. 2021; 38: 1331-1340
        • Sermondade N.
        • Sonigo C.
        • Sifer C.
        • Valtat S.
        • Ziol M.
        • Eustache F.
        • et al.
        Serum antimullerian hormone is associated with the number of oocytes matured in vitro and with primordial follicle density in candidates for fertility preservation.
        Fertil Steril. 2019; 111: 357-362