In vitro maturation as a fertility preservation strategy in cancer patients

Objective: To describe a case series on the use of in vitro maturation (IVM) technology in patients with cancer.

Materials and methods: This study included 34 patients aged 23–43 years who presented to the IVF Department of the Medsi on Solyanka Clinical and Diagnostic Center for fertility preservation programs. Transvaginal puncture of the antral follicles was performed, followed by aspiration of the follicular fluid. The resulting oocyte-cumulus complexes (OCCs) were matured for 24–48 h in an embryology laboratory.

Results: IVM were performed in 34 patients. In one case, no oocytes were retrieved, and in five cases, mature oocytes were not obtained after the culture. A total of 185 OCCs were retrieved, averaging 5.4 OCCs per patient. Additionally, 95 mature oocytes at the MII stage were retrieved, averaging 2.9 per patient, resulting in an average maturation rate of 51.8%. Oocyte cryopreservation was conducted in 13 patients, resulting in a total of 47 oocytes, or an average of 3.6 oocytes per patient. Fertilization was performed using oocytes obtained after IVM in 15 patients. In 10 cases, embryos were not produced (due to lack of cleavage or embryos being unsuitable for transfer according to the PGT-A results). In five cases, embryos suitable for transfer to the uterine cavity were obtained (either euploid according to PGT-A or PGT-A was not performed). Embryo storage continued in two cases, while one patient discontinued embryo storage. Two thawed embryos were transferred: one into the patient's uterine cavity, which did not result in pregnancy, and the other into a surrogate mother's uterus, resulting in pregnancy and delivery.

Conclusion: IVM is a promising approach for fertility preservation in patients with cancer in whom ovarian stimulation is not feasible. The effectiveness of this technique is influenced by the patient's baseline parameters, primarily age and ovarian reserve. However, further research is required to standardize the approaches and enhance the efficacy of this technology.