Laparoscopic oocyte retrieval for fertility preservation in a patient with squamous cell carcinoma of the vagina

Abstract

To describe a feasible fertility preservation strategy in a woman with vaginal carcinoma. Video case report demonstrating the diagnostic work-up and laparoscopic oocyte retrieval performed under regional anesthesia. University tertiary care hospital. A 35-year-old nullipara woman presenting with vaginal bleeding and foul-smelling vaginal discharge. After a comprehensive diagnostic work-up, a final diagnosis of squamous cell carcinoma of the vagina stage II (FIGO classification) was made. As per the patient's desire, before undergoing chemo-radiotherapy, the patient underwent oocyte cryopreservation. Transvaginal retrieval of oocytes was not feasible due to stenosis of the vaginal introitus and the potential risk of intracavitary tumor cell spillage. Transabdominal ultrasound-guided oocyte retrieval was not possible due to the body habitus. The patient underwent ovarian stimulation for in vitro fertilization. In order to minimize estrogen levels, letrozole was used during the controlled ovarian stimulation (COS). Laparoscopic oocyte retrieval was performed under spinal anesthesia. Successful laparoscopic egg retrieval and cryopreservation in a woman with squamous cell carcinoma of the vagina. A total follicular count of 9 was estimated before the oocyte retrieval. Eight oocytes were retrieved at laparoscopy, and eight mature oocytes were successfully cryopreserved. No complications were encountered, and the patient was discharged on the same day of surgery. To the best of our knowledge, this is the first published case of fertility preservation using the laparoscopic approach in a patient with vaginal cancer. Letrozole is a valuable strategy to reduce high estrogen in patients with gynecological cancer undergoing COS. Laparoscopy oocyte retrieval, performed under regional anesthesia, can be performed in an ambulatory setting and should be considered an effective fertility preservation strategy in patients with large vaginal tumors.