Fertility Preservation Success in Patient with Recurrent Ovarian Tumour
A multidisciplinary medical team enables a healthy birth despite low ovarian reserve and cancer.
1Clinical Presentation and Diagnosis
A 32-year-old woman presented with a recurrent borderline seromucinous ovarian tumour featuring microinvasion. Initially diagnosed at age 30, she underwent two surgeries within fifteen months. Following the second recurrence, her anti-Müllerian hormone level was recorded at 0.6 ng/ml, indicating a critically low ovarian reserve that complicated potential fertility preservation efforts.
2Multidisciplinary Treatment Strategy
Specialists at Milann Fertility and Birthing Hospital in Bengaluru managed the case. While definitive treatment typically involves removing both ovaries, fallopian tubes, and the omentum, the team prioritized the patient's desire for a genetically related child. They implemented a two-stage approach, surgically removing affected tissue while preserving viable ovarian remnants.
3Managing Ovarian Reserve Constraints
Scans revealed a complex cyst in the left ovary with only two visible follicles, while the right ovary remained unvisualized. To mitigate risks associated with the tumour, the medical team utilized a low-oestrogen stimulation protocol for IVF. This strategy aimed to minimize hormonal exposure while maximizing the chances of successful egg retrieval.
4Addressing Endometrial Health
The initial embryo transfer attempt failed to result in pregnancy. Subsequent clinical evaluation identified chronic endometritis, an inflammation of the uterine lining. The medical team successfully treated this condition using a targeted course of antibiotics followed by probiotics, ensuring the uterine environment was optimized before proceeding with the next stage of treatment.
5Natural Cycle Embryo Transfer
For the second attempt, the team opted for a natural-cycle frozen embryo transfer to avoid additional hormonal stimulation. A single high-quality embryo was transferred, resulting in a positive pregnancy test fourteen days later. An ultrasound at seven weeks confirmed a healthy singleton pregnancy, marking a significant milestone in the patient's care.
6Oncological Surveillance During Pregnancy
Throughout the pregnancy, the patient remained under strict oncological surveillance to monitor the recurrent tumour status. This dual-care approach allowed the medical team to balance maternal health with fetal development. The successful delivery of a healthy baby demonstrates the efficacy of integrating reproductive medicine with oncology in complex, high-risk patient cases.
7Personalized Reproductive Medicine Protocols
Consultant T. Shilpa Reddy emphasized that the priority was minimizing hormonal exposure while preserving fertility. By utilizing a personalized IVF approach and natural-cycle embryo transfer, the team successfully navigated the limitations imposed by the patient's low ovarian reserve and history of recurrent tumours, ultimately achieving a successful and healthy birth outcome.
8Implications for Fertility Preservation
This case highlights the potential for successful pregnancy in patients with recurrent ovarian tumours through highly tailored medical interventions. It underscores the importance of multidisciplinary collaboration between oncologists and reproductive specialists. Such personalized strategies offer viable pathways for patients who face severe fertility challenges due to aggressive, recurring reproductive system pathologies.