Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
UniCareD, University Cryobank for Assisted Reproductive Medicine and Fertility Protection at UniKiD, University Women's Hospital Düsseldorf, Düsseldorf, Germany.
Arch Gynecol Obstet. 2020 Oct;302(4):1019-1024. doi: 10.1007/s00404-020-05643-x. Epub 2020 Jun 17.
Female fertility preservation prior to gonadotoxic therapies can be achieved by the cryopreservation of ovarian cortical tissue. Immature oocytes may be recovered during the preparation, matured in vitro and lead to live births, thereby providing an additional option for fertility preservation. The purpose of this study was to test the feasibility of this approach in a setting with unilateral biopsy of a small piece of ovarian tissue and minimal tissue preparation prior to shipment to an external cryobank.
A prospective observational clinical study in an academic center was performed from January 2018 through December 2019. Ovarian tissue was obtained laparoscopically. Immature oocytes were recovered by minimal preparation of the tissue before shipment to an external cryobank for cryopreservation. In vitro maturation was performed on recovered immature oocytes.
Twelve patients were enrolled. Immature oocytes could be recovered for all. The maturation rate was 38.9% (n = 14/36). Metaphase II (MII) were either directly used for intracytoplasmic sperm injection (ICSI) with a fertilization rate of 66.6% (n = 4/6) or vitrified (n = 8). PNs were cryopreserved (n = 4). Vitrified MII were warmed with a post-warming vitality rate of 75.0% (n = 3/4) and used for ICSI with a fertilization rate of 33.3% (n = 1/3).
Immature oocytes can be successfully retrieved from ovarian tissue through minimal tissue preparation prior to shipment to a cryobank, matured in vitro, fertilized and cryopreserved for potential future fertility treatments. The total number of oocytes available for fertility preservation can be increased even without controlled ovarian stimulation in a situation where only ovarian biopsy for cryopreservation is performed.
German Clinical Trials Register (DRKS), DRKS00013170. Registered 11 December 2017, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013170 .
通过冷冻保存卵巢皮质组织，可以实现对性腺毒性治疗前的女性生育力保存。在准备过程中可以回收不成熟的卵母细胞，在体外成熟并导致活产，从而为生育力保存提供了另一种选择。本研究的目的是在单侧小块卵巢组织活检和在运送到外部冷冻库之前进行最小组织准备的情况下，测试这种方法的可行性。
一项在学术中心进行的前瞻性观察性临床研究于 2018 年 1 月至 2019 年 12 月进行。通过腹腔镜获取卵巢组织。在将组织运送到外部冷冻库进行冷冻保存之前，通过对组织进行最小的准备，回收不成熟的卵母细胞。对回收的不成熟卵母细胞进行体外成熟。
共纳入 12 例患者。所有患者均能回收不成熟的卵母细胞。成熟率为 38.9%（n=14/36）。中期 II 期（MII）直接用于胞浆内单精子注射（ICSI），受精率为 66.6%（n=4/6），或进行玻璃化（n=8）。PN 被冷冻保存（n=4）。玻璃化的 MII 解冻后活力率为 75.0%（n=3/4），并用于 ICSI，受精率为 33.3%（n=1/3）。
通过在将组织运送到冷冻库之前进行最小的组织准备，可以从卵巢组织中成功回收不成熟的卵母细胞，在体外成熟，受精并冷冻保存，以备未来的生育治疗。即使在仅进行冷冻保存的卵巢活检的情况下，不进行控制性卵巢刺激，也可以增加用于生育力保存的卵母细胞数量。
德国临床试验注册中心（DRKS），DRKS00013170。于 2017 年 12 月 11 日注册，https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013170。
