Abstract
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.
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References
Medicine ECotASfR. Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: an Ethics Committee opinion. Fertil Steril. 2018;110(6):1022–8.
Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2018;36(19):1994–2001.
Druckenmiller S, Goldman KN, Labella PA, Fino ME, Bazzocchi A, Noyes N. Successful oocyte cryopreservation in reproductive-aged cancer survivors. Obstet Gynecol. 2016;127(3):474–80.
Radeke EK, Zimmerman L, Bridge R, Adam M, Patel A. Oncocontraception in cancer care. Proc Am Soc Clin Oncol. 2017;35:e18018.
Peccatori FA, Azim H Jr, Orecchia R, Hoekstra H, Pavlidis N, Kesic V, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl_6):vi160–vi70.
Obstetricians ACo, Gynecologists. Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No. 121. Obstet Gynecol. 2011;118(1):184–96.
Kavanaugh ML, Jerman J, Finer LB. Changes in use of long-acting reversible contraceptive methods among US women, 2009–2012. Obstet Gynecol. 2015;126(5):917–27.
Eisenberg D, McNicholas C, Peipert JF. Cost as a barrier to long-acting reversible contraceptive (LARC) use in adolescents. J Adolesc Health. 2013;52(4):S59–63.
Adeleye AJ, Aghajanova L, Kao C-N, Cedars MI, Sauer MV. Impact of the levonorgestrel-releasing intrauterine device on controlled ovarian stimulation outcomes. Fertil Steril. 2018;110(1):83–8.
Friedenthal J, Maxwell S, Willson S, McCulloh D, Grifo J, Goldman K. The progestin-containing intrauterine device (IUD) during ovarian stimulation and oocyte retrieval: should it stay or should it go? Fertil Steril. 2017;108(3):e12.
Croxatto HB. Mechanisms that explain the contraceptive action of progestin implants for women. Contraception. 2002;65(1):21–7.
Tran ND, Aghajanova L, Kao C-N, Cedars MI, Rosen MP. Impact of pituitary suppression on antral follicle count and oocyte recovery after ovarian stimulation. Fertil Steril. 2016;105(3):690–6.
Balasch J, Miró F, Burzaco I, Casamitjana R, Civico S, Ballescá JL, et al. Endocrinology: The role of luteinizing hormone in human follicle development and oocyte fertility: evidence from in-vitro fertilization in a woman with long-standing hypogonadotrophic hypogonadism and using recombinant human follicle stimulating hormone. Hum Reprod. 1995;10(7):1678–83.
Mandernach MW, Beyth RJ, Rajasekhar A. Apixaban for the prophylaxis and treatment of deep vein thrombosis and pulmonary embolism: an evidence-based review. Ther Clin Risk Manag. 2015;11:1273.
Ishii R, Tachibana N, Okawa R, Enomoto M, Asami M, Toriumi R, et al. Different anti-Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART): clues to better ART outcomes. Reprod Med Biol. 2019;18(3):263–72.
Kaser DJ, Ginsburg ES, Carrell DT, Racowsky C. Assisted reproduction. Yen and Jaffe's Reproductive Endocrinology: Elsevier; 2019. p. 779-822. e16.
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Rushing, J.S., Appiah, L., Polotsky, A.J. et al. Ovarian stimulation for fertility preservation in an oncology patient with etonogestrel implant in place. J Assist Reprod Genet 38, 513–516 (2021). https://doi.org/10.1007/s10815-020-02057-1
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DOI: https://doi.org/10.1007/s10815-020-02057-1