Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, CT, 310 Cedar Street, FMB Room 224. New Haven, CT, USA.
Innovation Institute for Fertility Preservation, NY and CT, USA.
J Assist Reprod Genet. 2023 Dec;40(12):2777-2785. doi: 10.1007/s10815-023-02932-7. Epub 2023 Sep 16.
To assess the feasibility and outcomes of oocyte cryopreservation with in vitro maturation (IVM) in post-pubertal girls undergoing fertility preservation (FP) for primary ovarian insufficiency (POI) risk.
Ovarian stimulation was performed with an antagonist protocol or progesterone priming. Ultrasound monitoring was performed transabdominally. Oocytes were retrieved transvaginally under IV sedation. Immature oocytes were subjected to IVM for up to 36 h. All MII oocytes were vitrified. The main outcome measure was the total number of mature oocytes cryopreserved. The secondary outcome was the increase in the mature oocyte yield after IVM.
Indications for FP included mosaic Turner syndrome (mTS; n = 10), malignancy (n = 3), and POI risk (n = 2). The mean ± SD age, antral follicle count (AFC), and AMH levels were 14.2 ± 1.4 years, 8 ± 5.2 and 1.3 ± 1.3 ng/mL. In girls with mTS, the ovarian reserve was low for age (AFC 7.4 ± 4.7 and AMH 1.4 ± 1.6 ng/mL). Oocyte cryopreservation was possible in all girls with a range of 1-27 mature oocytes obtained, even in those who were previously exposed to chemotherapy or with low ovarian reserve, and no surgical complications were encountered. After IVM, the median mature oocyte yield increased significantly from 7.5 to 10.5 (p = 0.001).
Oocyte cryopreservation appears to be feasible and safe in girls as young as 12 years of age at risk for POI The utility of IVM increases the yield of cryopreserved mature oocytes. Prior exposure to chemotherapy or low ovarian reserve should not be an automatic reason to exclude these girls from FP consideration.
评估体外成熟（IVM）卵母细胞冷冻保存用于原发性卵巢功能不全（POI）风险的青春期后女孩进行生育力保存（FP）的可行性和结局。
采用拮抗剂方案或孕激素预激进行卵巢刺激。经腹超声监测。在 IV 镇静下经阴道取回未成熟卵母细胞。将不成熟卵母细胞进行 IVM 培养长达 36 小时。所有 MII 卵母细胞均进行玻璃化冷冻。主要观察指标为冷冻保存的成熟卵母细胞总数。次要观察指标为 IVM 后成熟卵母细胞产量的增加。
FP 的适应证包括镶嵌 Turner 综合征（mTS；n=10）、恶性肿瘤（n=3）和 POI 风险（n=2）。平均年龄±标准差、窦卵泡计数（AFC）和 AMH 水平分别为 14.2±1.4 岁、8±5.2 和 1.3±1.3ng/ml。在 mTS 女孩中，卵巢储备与年龄不成比例（AFC 7.4±4.7 和 AMH 1.4±1.6ng/ml）。所有女孩均可行卵母细胞冷冻保存，范围为 1-27 个成熟卵母细胞，即使是先前接受过化疗或卵巢储备低的女孩，也没有发生手术并发症。IVM 后，成熟卵母细胞的中位数产量从 7.5 显著增加至 10.5（p=0.001）。
对于有 POI 风险的 12 岁以下女孩，卵母细胞冷冻保存似乎是可行且安全的。IVM 的应用增加了冷冻保存成熟卵母细胞的产量。先前接触化疗或卵巢储备低不应成为将这些女孩排除在 FP 考虑之外的自动理由。
