JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):114
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263748

P-102. Fertility Preservation and Assisted Reproduction in a Couple with Multiple Infertility Factors and a History of Resected Non-Functioning Pancreatic Neuroendocrine Tumor: A Case Report.

Ana Clara Monteiro de Araujo¹, Julia de Lima Carvalho¹, Zoila Isabel Medina de La Paz², Marise Samamal², Joji Ueno², Fabio Ikeda²

¹ Universidade Federal de São Paulo - São Paulo - SP – Brasil
² Instituto Gera Centro de Ensino em Reprodução Humana - São Paulo - SP – Brasil

Objective: To report the fertility preservation strategy, assisted reproduction outcomes, and multidisciplinary management in a patient with multiple infertility factors and a history of surgically treated, low-grade, non-functioning pancreatic neuroendocrine tumor (PNET), a rare condition representing approximately 2% of all pancreatic tumors.
Methods: Descriptive observational case report study.
Results: A 36-year-old nulligravid woman, with a history of robotic pancreaticoduodenectomy (Whipple procedure) for a 4.4 cm low-grade, non-functioning pancreatic NET in 2018, was referred for infertility management and fertility preservation post-surgery. She had irregular cycles, ultrasound findings consistent with polycystic ovary syndrome, a submucosal fibroid, deep infiltrating endometriosis involving the uterosacral ligaments, and a one-year history of infertility. Initial fertility preservation was performed using an antagonist protocol (Fostimon), yielding 12 mature oocytes for cryopreservation. After one year of unsuccessful attempts at spontaneous conception, her 39-year-old male partner, a tobacco user, presented with asthenoteratozoospermia (Kruger 3%, motility 14%) and high sperm DNA fragmentation (39%). Initial use of 8 vitrified oocytes with ICSI (sperm processed via Zymot) resulted in 6 fertilized oocytes, none progressing beyond day 3. Following lifestyle counseling and an antioxidant diet — considering the patient's age of 37 years — a new stimulation cycle was performed with Pergoveris (antagonist protocol), yielding 16 mature oocytes and 8 blastocysts. Hysteroscopy revealed a 2 cm posterior wall submucosal fibroid (G1, Lasmar 1), which was resected. Endometrial preparation was conducted using an artificial cycle. The first attempt with vitrified oocytes did not produce transferable embryos. The second cycle produced high- quality blastocysts, with preimplantation genetic testing identifying one euploid embryo. After hysteroscopic myomectomy and confirmation of a normal uterine cavity, the embryo was transferred. Serum β-hCG was positive (140.4mIU/mL) and the pregnancy progressed uneventfully, culminating in a term delivery of a healthy newborn weighing 3,400 g. Four months after postpartum, the patient presented with a thyroid nodule measuring less than 1 cm, with a histopathological diagnosis of papillary carcinoma. However, breastfeeding did not need to be interrupted.
Conclusion: Fertility preservation should be offered to fertile cancer patients, even in cases of non-gonadotoxic tumors, when conception may be delayed or reproductive comorbidities coexist. In this specific scenario, reproductive counseling should be even more encouraged, given that PNETs may be associated with hereditary endocrinopathies, including multiple endocrine neoplasia type I (MEN1), an autosomal dominant syndrome. In vitro fertilization with preimplantation genetic testing (PGT) may be considered in such cases. In the present case, the patient opted not to undergo genetic testing. Moreover, individualized stimulation protocols in women with PCOS and prior oncologic surgery can yield satisfactory oocyte numbers. Severe male factor infertility, especially high sperm DNA fragmentation, may compromise fertilization and embryo development, requiring targeted interventions and possibly repeated stimulation cycles. Lifestyle modifications can significantly contribute to IVF success. Pre-transfer hysteroscopic correction of intrauterine pathologies, such as submucosal fibroids, is critical for optimizing implantation rates. A multidisciplinary approach integrating reproductive endocrinology, oncology, and urology was essential for a favorable outcome.