Ovarian stimulation for fertility preservation in an oncology patient with etonogestrel implant in place

• Published in: Journal of assisted reproduction and genetics 2021-02, Vol.38 (2), p.513-516
• Main Authors: Rushing, John S., Appiah, Leslie, Polotsky, Alex J., Murray, Shona, Foust, Erin, Hassell, Kathryn, Roeca, Cassandra
• Format: Article
• Language: English
• Subjects: 17β-Estradiol; Adult; Anti-Mullerian Hormone - administration & dosage; Chemotherapy; Contraception; Cryopreservation; Desogestrel - administration & dosage; Female; Fertility; Fertility Preservation; Follicle Stimulating Hormone - administration & dosage; Follicle-stimulating hormone; Follicles; Gonadotropin-Releasing Hormone - administration & dosage; Gonadotropins; Gynecology; Human Genetics; Humans; Infertility, Female - drug therapy; Infertility, Female - etiology; Infertility, Female - metabolism; Infertility, Female - pathology; Luteinizing hormone; Luteinizing Hormone - administration & dosage; Medicine; Medicine & Public Health; Metaphase; Neoplasms - complications; Neoplasms - pathology; Oocyte Retrieval - methods; Oocytes; Oocytes - drug effects; Oocytes - growth & development; Oogenesis - drug effects; Oogenesis - genetics; Ovarian Hyperstimulation Syndrome; Ovaries; Ovulation Induction - methods; Pituitary (anterior); Prostheses and Implants - adverse effects; Reproductive Medicine; Sarcoma; Vitrification
• ISSN: 1058-0468; 1573-7330; 1573-7330
• DOI: 10.1007/s10815-020-02057-1

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.