Abstract
BackgroundOocyte in vitro maturation (IVM) and cryopreservation at the time of routine ovarian tissue freezing may be offered to cancer patients as an additional option for fertility preservation. This study aimed to investigate the developmental capacity of oocytes isolated from unstimulated ovaries.MethodsImmature oocytes (n = 63) from seven consenting premenopausal patients were analysed. Oocytes were collected during routine laparoscopic examination with biopsy of an ovary (cystic adnexal mass, n = 3; cervical adenocarcinoma, n = 2) or oophorectomy (sex reassignment surgery, n = 2) without previous stimulation of the ovaries. The stage of the patient’s menstrual cycle was not considered. Oocytes in all visible antral follicles were aspirated from ovaries, cultured in IVM medium and vitrified at the MII stage before being kept in liquid nitrogen for at least one month. After warming, oocytes were subjected to parthenogenetic activation by chemical stimulus. Their further development was recorded at intervals of 24 hours for up to 6 days of culture.Results61.9% of oocytes matured in vitro within 48 hours. The survival rate after vitrification and warming was 61.5%. A total of 75% of surviving oocytes were able to respond to artificial activation, 44.4% of the parthenotes developed to early embryonic stage. However, only 1 in 18 (5.6%) of the resulting embryos reached blastocyst stage.ConclusionsOocytes matured in vitro from unstimulated ovaries seem to have limited developmental potential after cryopreservation and artificial activation. Although the outcome of IVM for non-stimulated oocytes is poor, it is currently the only chance besides cryopreservation of ovarian tissue for women for whom ovarian stimulation is not possible due to life circumstances. Based on our preliminary results, we suggest that the use of cryopreserved ovaries for fertility preservation in women with cancer warrants further investigation.
Highlights
Oocyte in vitro maturation (IVM) and cryopreservation at the time of routine ovarian tissue freezing may be offered to cancer patients as an additional option for fertility preservation
At the time of collection, all oocytes were at the germinal vesicle (GV) stage
Our results show that IVM can be achieved in immature oocytes isolated from ovaries without taking account of the phase of the menstrual cycle in which they are collected, and without any hormonal stimulation
Summary
Oocyte in vitro maturation (IVM) and cryopreservation at the time of routine ovarian tissue freezing may be offered to cancer patients as an additional option for fertility preservation. Depending on the type and stage of cancer— especially blood-borne cancer and those with potential danger of metastasis to ovaries—there is a risk of transmission of malignant cells when ovarian cortical tissue is cryopreserved and later used to restore fertility by autografting (retransplantation) [7,8,9]. In the latter situation, isolation of oocytes from antral follicles at the time of freezing of the ovarian tissue, with maturation in vitro before the oocytes are cryopreserved, can be considered as an alternative approach. This study aimed to investigate the developmental potential of oocytes matured in vitro after cryopreservation and artificial activation by chemical stimulus
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