Work

The progestin anchor: salvaging mature oocyte yield after an unplanned six-day gonadotropin pause in oncofertility—a case report

Year: 2026

Type: article

Abstract: Objective: To describe the retrieval of mature oocytes after an unplanned 6-day gonadotropin-free interval during oncofertility ovarian stimulation. Design: Case report. Subjects: A 22-year-old active-duty soldier with a serous borderline ovarian tumor undergoing fertility preservation after ovarian surgery. Exposure: Progestin-primed ovarian stimulation using follitropin alfa and medroxyprogesterone acetate as the sole luteinizing hormone suppressor. Gonadotropin administration was unexpectedly interrupted for 6 days because of a nondeferrable military summons, while oral medroxyprogesterone acetate was maintained. Main Outcome Measures: Metaphase II (MII) oocyte yield and maturation rate. Results: The patient had undergone ovarian surgery approximately 9 months before the reference cycle and 12 months before the index cycle. Baseline antimüllerian hormone before fertility preservation was 1.77 ng/mL. In the reference cycle, 13 follicles ≥14 mm were present on the trigger day, and 13 oocytes were retrieved, including six MII oocytes that were vitrified. At the ultrasound assessment immediately preceding the gonadotropin-free interval in the index cycle, ultrasound showed nine visible follicles, including three follicles measuring <14 mm and six follicles measuring ≥14 mm. After the 6-day interval, the trigger-day ultrasound showed seven follicles ≥14 mm in diameter, ranging from 17 to 19 mm. Estradiol remained nearly stable across the interval, from 1,612 to 1,580 pg/mL, and endogenous progesterone on the trigger day was 1.1 ng/mL. Seven oocytes were retrieved, including five MII oocytes that were vitrified. Conclusion: In this selected oncofertility patient undergoing progestin-primed ovarian stimulation, an unplanned 6-day gonadotropin-free interval did not preclude retrieval of a clinically meaningful number of mature oocytes. Continuous medroxyprogesterone acetate may represent a biologically plausible protective factor against premature luteinization, although causality cannot be inferred from a single case.

Source: F&S Reports

DOI: 10.1016/j.xfre.2026.07.001

Authors: Przemysław Ciepiela, Arkadiusz Adamczyk, Joanna Aszkiełowicz, Weronika Józefowska, Grzegorz Mrugacz

Institution: Bocian Fertility Clinic

Language: English

Topic: Reproductive Biology and Fertility

Subfield: Reproductive Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,000