Purpose

To describe a case of a young woman who presented for fertility preservation and underwent ovarian stimulation with an etonogestrel implant in place.

Methods

A 24-year old, gravida 0, with an etonogestrel implant and newly diagnosed lower extremity sarcoma and DVT desiring oocyte cryopreservation prior to adjuvant chemotherapy and radiation. To avoid delay in her oncologic care and allow for continued use of contraception post-retrieval, the patient underwent controlled ovarian hyperstimulation (COH) without removal of the etonogestrel implant.

Results

Baseline labs included follicle-stimulating hormone 9 mIU/mL, luteinizing hormone 4.9 mIU/mL, estradiol 42 pg/mL, anti-Müllerian hormone 5.1 ng/mL, and antral follicle count greater than 40. The patient was placed on an antagonist protocol and stimulated with 125 IU Gonal-F and 75 IU Menopur. She received a total of 12 days of gonadotropin stimulation. On the day of trigger, her estradiol was 1472 pg/mL, lead follicle 21.5 mm with a total of 25 follicles measured > 12 mm. She was triggered with 5000 U hCG. She had a total of 23 oocytes retrieved, 17 of which were metaphase II and vitrified.

Conclusions

COH and successful oocyte cryopreservation can be achieved in patients with an etonogestrel implant in situ without apparent detrimental effects to oocyte yield or maturity. Due to the etonogestrel implant’s inhibitory effects on LH, it is recommended to use an hCG trigger for final oocyte maturation.

中文翻译：

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卵巢刺激以保留依托孕烯植入物的肿瘤患者的生育能力

目的

描述一例因保留生育能力而接受卵巢刺激并植入依托孕烯的年轻女性。

方法

一名 24 岁，妊娠 0 级，植入依托孕烯和新诊断的下肢肉瘤和 DVT，希望在辅助化疗和放疗之前冷冻保存卵母细胞。为了避免延误她的肿瘤治疗并允许在取出后继续使用避孕措施，该患者接受了控制性卵巢过度刺激（COH），而没有移除依托孕烯植入物。

结果

基线实验室包括促卵泡激素 9 mIU/mL、促黄体生成素 4.9 mIU/mL、雌二醇 42 pg/mL、抗苗勒管激素 5.1 ng/mL，以及窦卵泡计数大于 40。患者接受拮抗剂方案并用 125 IU Gonal-F 和 75 IU Menopur 进行刺激。她总共接受了 12 天的促性腺激素刺激。在触发当天，她的雌二醇为 1472 pg/mL，前导卵泡 21.5 mm，总共 25 个卵泡测量值 > 12 mm。她被 5000 U hCG 触发。她总共取回了 23 个卵母细胞，其中 17 个处于中期 II 并玻璃化。

结论

在原位植入依托孕烯的患者中可以实现 COH 和成功的卵母细胞冷冻保存，而不会对卵母细胞的产量或成熟度产生明显的不利影响。由于依托孕烯植入物对 LH 的抑制作用，建议使用 hCG 触发最终卵母细胞成熟。