Bypassing physiological puberty, a novel procedure of oocyte cryopreservation at age 7: a case report and review of the literature

Abstract

Objective: To report the first successful oocyte cryopreservation in a prepubertal girl.

Design: Case report and review of the literature.

Setting: Tertiary medical center.

Patient(s): A 7-year-old prepubertal girl with Turner syndrome mosaicism (45,X[37]/47,XXX[15]) who underwent a novel fertility preservation procedure after fertility preservation counseling and informed decision of the parents.

Intervention(s): Controlled ovarian hyperstimulation with daily administration of 100 IU recombinant human follicle-stimulating and 50 IU recombinant human luteinizing hormone per milliliter, injection of 250 μg human chorionic gonadotropin was given 36 hours before the follicular aspiration procedure, and oocytes retrieved by a transabdominal ultrasound guided approach.

Main outcome measure(s): Mature oocyte cryopreservation.

Result(s): The first cryopreservation cycle with use of a gonadotropin-releasing hormone agonist trigger failed to yield oocytes. The second cycle with human chorionic gonadotropin trigger was successful. Six oocytes were retrieved, and all were mature metaphase 2. The patient was discharged in good condition with no complications.

Conclusion(s): This novel procedure bypasses the timely physiologic progression of pubertal maturation of the hypothalamic-pituitary-ovarian axis to directly target the ovaries and achieve mature ovarian follicles. This innovative approach offers a new treatment modality for prepubertal girls who need fertility preservation such as in Turner syndrome or in cases that ovarian tissue cryopreservation is contraindicated.

Keywords: Controlled ovarian stimulation; Turner syndrome; oocyte cryopreservation; prepubertal girl; transabdominal oocyte retrieval.