Successful pregnancy after fertility preservation using OTO-IVM method in ovarian cancer

Fertility preservation in women of reproductive age with ovarian cancer is still challenging. The ovarian-sparing surgery may increase the risk of recurrence. The direct involvement of the ovary in the tumor process significantly limits the ability to implement the most effective fertility preservation methods. For example, ovarian stimulation and ovarian cortex cryopreservation are absolutely contraindicated due to the risk of tumor cell contamination. In such cases, the only feasible fertility preservation method may be OTO-IVM (Ovarian Tissue Oocyte In Vitro Maturation), which involves retrieving immature oocytes from ovarian tissue removed during surgery and subsequent in vitro maturation.

Clinical Case Description. We present a case of successful pregnancy achieved through comprehensive, multidisciplinary fertility preservation. A 30-year-old patient with a recurrent borderline ovarian tumor in her only remaining ovary underwent surgery with uterine preservation and removal of the affected ovary. From the tumor-involved ovary, 22 cumulus-oocyte complexes were obtained. Following OTO-IVM, 12 metaphase II oocytes were obtained and fertilized via intracytoplasmic sperm injection (ICSI) that resulted in 3 blastocyst-stage embryos, which were cryopreserved. Cyclic hormone replacement therapy was administered to the patient. Nine months later, one embryo was thawed and transferred into the uterine cavity. Currently, an ongoing 20-week pregnancy has been confirmed.

Conclusion. The OTO-IVM method holds significant value as a fertility preservation technique for patients with ovarian cancer, making childbirth achievable. Further research is needed to refine the method, optimize protocols, and define clear indications and contraindications for its application.

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