Triple stimulation (TriStim) before bilateral oophorectomy in a young woman with ovarian cancer: a case report and revie
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(2020) 6:17
CASE REPORT
Open Access
Triple stimulation (TriStim) before bilateral oophorectomy in a young woman with ovarian cancer: a case report and review of the literature Laura C. Gemmell1* , Jason D. Wright2 and Paula C. Brady3
Abstract Background: Double ovarian stimulation (DuoStim) involves two rounds of controlled ovarian stimulation (COS) and oocyte retrieval in immediate succession. It represents a promising approach to increase oocyte yield for patients with diminished ovarian reserve or those with limited time before fertility-threatening oncologic treatment. We report the case of a 31-year-old woman with Stage IC endometrioid ovarian cancer who underwent a triple stimulation or “TriStim,” completing three rounds of COS and oocyte retrieval within 42 days prior to bilateral salpingo-oophorectomy. Case presentation: A 31 year old nulligravid woman presented for fertility preservation counseling following a bilateral ovarian cystectomy that revealed Stage IC endometroid adenocarcinoma arising within endometrioid borderline tumors. The patient was counseled for bilateral salpingo-oophorectomy, lymph node dissection, and omentectomy followed by three cycles of carboplatin/paclitaxel. Prior to this, all within six weeks, the patient underwent three rounds of controlled ovarian stimulation using an antagonist protocol and human chorionic gonadotropin (hCG) trigger, resulting in vitrification of nine two-pronuclear zygotes (2PN), after which definitive surgery was performed. Conclusions: Advantages of DuoStim procedures are increasingly recognized, especially for oncology patients with limited time before potentially sterilizing cancer treatment. To our knowledge, this is the first report of a triple stimulation (“TriStim”). Our case highlights that triple stimulation is a viable option for patients needing urgent fertility preservation in order to maximize egg and embryo yield within a limited time period. Keywords: Double ovarian stimulation, DuoStim, Fertility preservation, Oncofertility, Triple stimulation, TriStim
Background Traditional teaching of follicular development focuses on a single cohort of antral follicles that grow in response to gonadotropins in the early follicular phase of the menstrual cycle. As a result, conventional ovarian * Correspondence: [email protected] 1 Department of Obstetrics and Gynecology, Columbia University Irving Medical Center/New York Presbyterian Hospital, 622 west 168th street, New York, NY 10032, USA Full list of author information is available at the end of the article
stimulation begins on cycle day two or three. With advances in transvaginal ultrasound, studies have challenged the traditional paradigm by suggesting that women experience waves of follicular growth during the interovulatory interval [1]. Waves of folliculogenesis allow for “random start” and double ovarian stimulation protocols. “Random start” refers to ovarian stimulation initiated at any time during the menstrual cycle, ideal for patients with limited time
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