The Activation of Residual Dormant Follicles by Human Chorionic Gonadotropin (HCG) in Vivo: a Novel Treatment for Premature Ovarian Insufficiency

BackgroundWith the influence of factors such as ovarian surgery, high-dose radiotherapy and chemotherapy, environmental degradation, and bad living habits, the occurrence of premature ovarian insufficiency(POI) is getting younger and younger, and many young women's ovaries have entered the aging stage earlier. While many studies have investigated the patients with POI, which is still a challenge in reproductive medicine as the treatments available now are not ideal. POI patients have varying amounts of residual dormant follicles in the ovaries. Therefore, it is critical to further our understanding of primordial follicle activation in order to treat.This study aimed to investigate the activation of residual follicles in POI patients with injection of HCG, whether they could obtain embryos and become pregnant.Methods Four patients with POI were pretreated with dehydroepiandrosterone, Coenzyme Q10, estrogen and medroxyprogesterone. The prescribed amounts of estrogen and medroxyprogesterone were adjusted to maintain the level of FSH at ˂15 mIU/ml and the level of LH˂10 mIU/ml. When the treatments failed to induce the appearance of follicles after 3 months, the patients received treatment with 10000 IU of HCG. Results The residual dormant follicles in POI patients can be activated using our approach to obtain embryos and conceive by injection of HCG. ConclusionsPOI patients may conceive their own genetic children by activating dormant follicles in vivo. These findings may represent a new simple and feasible solution for the treatment of patients with POI to conceive their own genetic children.

The Significance of Planned Fertility Preservation for Women With Endometrioma Before an Expected Ovarian Cystectomy

Endometrioma is known to reduce the ovarian reserve and the extent of the decrease is more severe when ovarian surgery is performed. Therefore, to prevent this decline in fertility, patients with endometrioma are considered candidates for preoperative fertility preservation (FP). In this study, we evaluate the efficacy of FP in women with endometrioma before planned ovarian surgery. A total of 95 cycles in 62 patients with endometrioma, undergoing controlled ovarian stimulation (COS) for FP using a gonadotropin-releasing hormone (GnRH) antagonist protocol before an expected ovarian surgery, were enrolled retrospectively. COS outcomes were compared according to endometrioma laterality. Additionally, first COS cycle outcomes in patients with endometrioma were compared with those in infertile patients, or in patients with a benign ovarian cyst using propensity score matching. When multiple COS cycles were performed, the results of cumulative cycles were analyzed. Embryo quality was worse in the bilateral endometrioma group. Compared with the infertile patient group, the patients with endometrioma had significantly lower Anti-Müllerian Hormone (AMH) and fewer numbers of oocytes retrieved (median, 3.3 vs. 1.2, p<0.001; 7.0 vs. 4.0, p=0.009, respectively). Compared with mature oocytes in infertile patients or patients with a benign cyst, mature oocytes were fewer in patients with endometrioma, but this was not statistically significant (median, 4.0 vs. 3.0, p=0.085; 5.5 vs. 3.0, p=0.052, respectively). The median value of the cumulative number of cryopreserved oocytes or embryos was 14.5 up to the fourth cycle compared to 3 up to the first cycle, with cumulative effect. Women with endometrioma should be counseled for FP before planned ovarian cystectomy. The number of cryopreserved oocytes or embryos can be increased by repeated cycles.

O-057 The impact of diagnosis endometriosis as part of the fertility workup

Abstract text The impact of diagnosis endometriosis as part of the Fertility workup Endometriosis is a multifaceted disease that may go from completely asymptomatic to a debilitating condition with severe pelvic pain complicated infertility. In the last few years, how we approach fertility in women with endometriosis has clearly changed, postponing definitive/radical surgery till the patient has completed her family. As a clear association exists with endometriosis and infertility, during the fertility workup it is one of the diseases to investigate, as it may have been missed in previous annual gynecologic checkups. Here we may face two problems: a) the stigma of diagnosis a young women with the label “endometriosis”, as she may be under the pressure of a progressive disease that may or may not affect her quality of life, and b) if the diagnosis of endometriosis is positive, how this may affect the decision making process during the fertility journey. In this lecture we will discuss the difficulties of early diagnosis of endometriosis, why most of the previous test have failed, and the new opportunity that miRNAs seem to offer. Once endometriosis is diagnosed –early or late stages- how this may affect spontaneous chances of pregnancy, ovarian reserve, oocyte and embryo quality, endometrial receptivity, and last but not least, time to pregnancy. Obviously, the prognosis changes over time, and women’s age will be conditioning most of our decisions. We will try to identify whom to treat, to increase the absolute pregnancy rate, and when to treat, to reduce the time to pregnancy. Finally, we will discuss the opportunity of fertility preservation in this particular subgroup of women. Being aware of the potential damage that endometriosis by itself, or the associated ovarian surgery, may inflict on ovarian reserve make these women more proactive for fertility preservation.

Ovarian cyst elevation using a metreurynter for laparoscopic cystectomy of a benign ovarian cyst during pregnancy

Background A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a metreurynter with the success rate of the procedure and a comparison of surgical results and pregnancy outcomes between the successful and unsuccessful cases. Methods Between August 2003 and February 2020, 11 pregnant patients with a tumor found sunk in the Cul-de-sac underwent laparoscopic cystectomy for a benign ovarian cyst with a metreurynter. The surgical results, success and failure of the elevation by a metreurynter, pregnancy outcomes, and fetal status at delivery were evaluated. Results Elevation of ovarian tumors with a metreurynter was successful in nine cases. However, it was unsuccessful in the remaining two cases wherein the ovary was lifted with forceps while the uterus was in a compressed state. The operative time was also longer in these cases. The pregnancy prognosis, however, was good for both, successful and unsuccessful cases. Conclusions The metreurynter is an inexpensive and practical obstetric device, and its optimal use allows the performance of a procedure with minimal burden on a pregnant uterus. Therefore, we recommend the appropriate use of this method to enable effective laparoscopic cystectomy of ovarian tumors during pregnancy.

Criopreservação de oócitos no menacme: aconselhamento e indicações / Oocyte cryopreservation in the menacme: counseling and indications

Introdução: Os avanços nas técnicas de reprodução assistida têm possibilitado a preservação da fertilidade em mulheres que desejam adiar a maternidade ou naquelas que têm seu potencial reprodutivo ameaçado. Nesse contexto, a introdução da vitrificação de oócitos foi um avanço significativo na tecnologia reprodutiva, e vem mostrando resultados similares aos obtidos com oócitos frescos. Objetivo: O presente estudo tem como objetivo rever as principais indicações para a criopreservação de oócitos. Métodos: Foi feita uma revisão narrativa da literatura, pautada nos descritores e nos termos mais utilizados para vitrificação de oócitos, tendo como base LILACS, SciELO e PubMed. Resultados e conclusão: Baseado no atual nível de evidência, a criopreservação de oócitos não deve mais ser considerada técnica experimental. Foram observadas algumas indicações para vitrificação de oócitos entre elas destacam–se: mulheres saudáveis que desejam postergar a gestação, mulheres que serão submetidas a tratamentos gonadotóxicos e cirurgias ovarianas extensas, programas de ovodoação e vitrificação com o propósito de flexibilizar os protocolos de reprodução assistida.Palavras chave: Criopreservação, Preservação da fertilidade, Vitrificação, Oócitos, Infertilidade ABSTRACTIntroduction: Advances in assisted reproductive techniques have allowed preservation of fertility among women who wish to postpone maternity or have their reproductive potential threatened. In this context, the introduction of oocyte vitrification has evidenced to be a remarkable technological progress, and has shown similar results to those obtained with fresh oocytes. Objective: The present study aims to review the main indications of oocyte cryopreservation. Methods: A narrative review of the literature was carried out, based on the descriptors and terms most used for oocyte vitrification, based on LILACS, SciELO and PubMed. Results and conclusion: Based on the current level of evidence, oocyte cryopreservation should no longer be considered an experimental technique. Patients are accessing and receiving oocyte cryopreservation for a wide range of indications, among them the following stand out: healthy women who wish to postpone pregnancy, women who will undergo gonadotoxic treatments and extensive ovarian surgery, ovodoation and vitrification programs with the purpose of making assisted reproduction protocols more flexible.Keywords: Cryopreservation, Fertility preservation, Vitrification, Oocyte, Infertility

Ecografía pélvica: correlación de la evolución de útero y ovarios con estadios de Tanner de mama y edad

Objective: To correlate the ultrasound evolution of the uterus and ovaries, according to Tanner’s stages of breast and chronological age in patients attending the children’s and juvenile gynecology clinic of the children’s hospital “Dr. José Manuel de los Ríos “between March and October 2016. Methods: 113 patients aged between 7.7 and 15.5 years were evaluated. From them were excluded those ones who had presented menarche, urogynecologic malformation, endocrinopathy or a history of uterine or ovarian surgery. They were classified according to Tanner stages of breast. Transabdominal pelvic ultrasound was performed, additionally uterus and ovaries were measured and described. We calculated the mean standard deviation and median according to the type of variable, we applied an ANOVA non-parametric test of Kruskal-Wallis and chi-square of Pearson, it can be considered a statistically significant value if p <0.05. Results: Uterine length ranged from 33 mm in patients with Tanner I up to 52 mm in those with Tanner IV. Body/cervix ratio was 0.9 in patients with stage I, 1.12 with stage II, 1.42 with stage III and 1.30 with stage IV. A statistically significant relationship was found between ovarian volumes with both age groups and Tanner stages. As for the ovarian pattern, the most frequent one was the microfollicular. Conclusions: The uterus and ovaries show continuous growth in relation to age and the Tanner stage of breast, those factors with which a statistically significant relationship was demonstrated. Keywords: Pelvic ultrasound, uterus, ovaries, Tanner stages of breast.