Live birth after in-vitro maturation of oocytes in a patient with specific ovarian insufficiency caused by long-term mitotane treatment for adrenocortical carcinoma
| Autor: | Florine Belin, Christophe Sifer, Hélène Bry-Gauillard, Jacques Young, C. Vinolas, Nathalie Massin, Michael Grynberg, Peggy Renoult-Pierre |
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| Rok vydání: | 2021 |
| Předmět: |
Infertility
Male Primary Ovarian Insufficiency Andrology Pregnancy Follicular phase Adrenocortical Carcinoma Medicine Adrenocortical carcinoma Humans Mitotane Fertility preservation Ovarian Diseases Ovarian cyst business.industry Obstetrics and Gynecology medicine.disease Antral follicle Adrenal Cortex Neoplasms In vitro maturation In Vitro Oocyte Maturation Techniques Reproductive Medicine Oocytes Female business Live Birth Developmental Biology medicine.drug |
| Zdroj: | Reproductive biomedicine online. 44(2) |
| ISSN: | 1472-6491 |
| Popis: | Research question How should the fertility of a woman with persistent specific ovarian dysfunction after long-term mitotane exposure be managed? Design Case report. A 33-year-old woman who underwent surgery for adrenocortical carcinoma and treated with mitotane was referred for infertility. She rapidly became amenorrhoeic while taking mitotane, a condition that persisted for 5 years after cessation. Repeated serum hormone evaluation showed collapsed androgen levels, low oestradiol, high gonadotrophins (LH 69 and 63; FSH 23 and 43 IU/l), relatively high inhibin B level and slightly decreased anti-Mullerian hormone levels (1.4 and 0.7 ng/ml). An ultrasound scan revealed an antral follicle count of 13, contrasting with high serum gonadotrophin levels. After failure to obtain follicular growth after ovarian stimulation, in-vitro maturation (IVM) of immature oocytes aspirated from the antral follicles was carried out for microinjection with the spermatozoa of the patient's partner. Results Two cycles of unstimulated egg retrieval were carried out, producing seven IVM oocytes, which were microinjected. A total of three cleavage-stage embryos were vitrified and unsuccessfully transferred after endometrial preparation using hormone replacement therapy (HRT). After a 20-month break, two new attempts were carried out under HRT with the aim of achieving a fresh embryo transfer. The last attempt succeeded after transfer of a single day-2 embryo, and the patient delivered a healthy baby. Conclusion Persistent specific impaired ovarian function 5 years after withdrawal of mitotane, and the first live birth after IVM in this situation, are reported. The question of fertility preservation before long-term mitotane treatment is raised. |
| Databáze: | OpenAIRE |
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