Reproductive Unit, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Zaloska cesta 002, 1000, Ljubljana, SI, Slovenia.
Reprod Biol Endocrinol. 2018 Apr 5;16(1):33. doi: 10.1186/s12958-018-0350-1.
Some reports show that it is possible to isolate immature oocytes from human ovarian tissue retrieved by a cortex biopsy or ovariectomy of non-stimulated ovaries and mature them in vitro. The mature oocytes can be vitrified and stored for in vitro fertilization, which, along with ovarian tissue cryopreservation, is mostly practiced in young cancer patients to preserve their fertility. There is much less data on this new approach in women with a natural ovarian insufficiency, which can be caused by different factors, including viral infection. In this case report this advanced methodology was used in a young patient suffering from ovarian insufficiency which was possibly associated with Epstein-Barr virus and infectious mononucleosis (glandular fever).
This case report included a 27-year-old patient who attended our infertility clinic because of ovarian failure as a part of autoimmune polyendocrinopathy that occurred after Epstein-Barr virus infection, which has rarely been reported until now. Although antral follicles were observed in her ovaries by ultrasound monitoring, she was amenorrhoeic with menopausal concentrations of follicle-stimulating hormone (FSH) and without mature follicles. Therefore, a small biopsy of ovarian cortex tissue was performed using laparoscopy to retrieve immature oocytes. The retrieved oocytes were matured in vitro, cryopreserved, and stored for in vitro fertilization and potential pregnancy.
Four immature, germinal vesicle (GV) oocytes were found and removed from tissue, denuded mechanically by a pipette, and matured in vitro in a maturation medium with added FSH and hCG as well as in co-culture with cumulus cells, which were retrieved by their denudation. Three oocytes matured in vitro to the metaphase II (MII) stage and were vitrified for in vitro fertilization along with ovarian tissue cryopreservation.
Our results show that Epstein-Barr infection is possibly associated with autoimmune ovarian failure. The devastating impact on fertility in such disorder can be successfully avoided by in vitro maturation of oocytes from excised ovarian tissue.
一些报道表明，从非刺激卵巢的卵巢组织皮质活检或卵巢切除术中分离未成熟卵母细胞并在体外成熟是可能的。成熟的卵母细胞可以进行玻璃化冷冻保存，用于体外受精，这与卵巢组织冷冻保存一起，主要在年轻的癌症患者中进行，以保留他们的生育能力。在因不同因素（包括病毒感染）导致的自然卵巢功能不全的女性中，关于这种新方法的数据要少得多。在本病例报告中，这种先进的方法被用于一名患有卵巢功能不全的年轻患者，该患者可能与 EBV（Epstein-Barr 病毒）和传染性单核细胞增多症（腺热）有关。
本病例报告包括一名 27 岁的患者，因 EBV 感染后发生的自身免疫性多内分泌腺病的一部分卵巢衰竭而到我们的不孕不育诊所就诊。尽管她的卵巢通过超声监测观察到了窦卵泡，但她闭经，卵泡刺激素（FSH）达到绝经浓度，没有成熟卵泡。因此，使用腹腔镜对卵巢皮质组织进行了小的活检，以获取未成熟的卵母细胞。体外成熟、冷冻保存，并储存用于体外受精和潜在妊娠。
从组织中发现并取出了四个未成熟的生发泡（GV）卵母细胞，通过移液器机械去卵丘，在添加 FSH 和 hCG 的成熟培养基中以及与卵丘细胞共培养中体外成熟，这些卵丘细胞通过去卵丘获得。三个卵母细胞在体外成熟到中期 II（MII）阶段，并与卵巢组织冷冻保存一起进行玻璃化冷冻保存用于体外受精。
我们的结果表明 EBV 感染可能与自身免疫性卵巢衰竭有关。通过从切除的卵巢组织中体外成熟卵母细胞，可以成功避免这种疾病对生育能力的破坏性影响。
