Human Chorionic Gonadotropin Injection to Retrieve Mature Oocytes During Laparoscopic Surgery for Ovarian Tissue Cryopreservation: A Case Report

TL;DR

A 15-year-old cancer patient had both ovarian tissue and a mature egg preserved using hCG before surgery, offering a potential fertility option.

Contribution

Demonstrates successful use of hCG to retrieve mature oocytes during OTC surgery in a pubertal girl.

Findings

hCG injection before surgery enabled retrieval of one mature oocyte in a pubertal patient.

Combining OCP and OTC was feasible during laparoscopic surgery for fertility preservation.

The patient resumed menstruation and had small follicles visible for aspiration.

Abstract

For young women with cancer facing the risk of infertility due to upcoming chemotherapy or radiotherapy, embryo cryopreservation (ECP), oocyte cryopreservation (OCP), and ovarian tissue cryopreservation (OTC) have been proposed. For some adolescent and adult patients who need immediate initiation of cancer treatment as well as prepubertal patients, only OTC is an option for fertility preservation. However, OCP is recommended for patients who can choose both OCP and OTC because the live birth rate after OTC is still insufficient. In this case, we were able to perform OCP as well as OTC with human chorionic gonadotropin (hCG) injection before surgery for a pubertal girl. The parents of a 15-year-old girl undergoing radiotherapy and chemotherapy (vincristine) after brain surgery for medulloblastoma approached our department to request fertility preservation for their daughter. Her menstruation had stopped, and maintenance chemotherapy (cisplatin, vincristine, cyclophosphamide) was scheduled one month after the current treatment ended. We informed them about the utility of each fertility preservation method and recommended OTC for the patient during her break from chemotherapy. The parents desired OCP because the pregnancy rate for OTC and ovarian tissue transplantation (OTT) was not satisfactory. With magnetic resonance imaging (MRI) showing small follicles and the resumption of menstruation in the patient, we decided to conduct follicle aspiration for OCP during surgery for OTC. Thirty-five hours before laparoscopic oophorectomy for OTC, hCG was injected. During laparoscopic surgery, all three small follicles that were visible were manually aspirated with an 18-gauge needle. Two oocytes, one mature and one degenerated, were retrieved. The mature oocyte and unilateral ovarian tissue were cryopreserved. The patient was discharged two days after OTC and returned four days later for maintenance chemotherapy. For young patients with cancer undergoing OTC, hCG administration may be an effective therapeutic option for retrieving mature oocytes during surgery.

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