JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):191
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263894

P-179. Pregnancy after Fertility Preservation for Anaplastic Oligodendroglioma Using Bi-Stim With Oral Progestin: A Case Report

Beatriz Mendes de Araujo¹, Anamaria Baquero Perilla¹, Amanda Ribeiro Batlle¹, Caio Parente Barbosa¹, Renato De Oliveira¹

¹ Instituto Ideia Fértil de Saúde Reprodutiva - São Paulo – SP - Brasil

Objective: This study aims to describe a clinical case of oncofertility preservation in a young patient diagnosed with a rare cancer, using double ovarian stimulation (bi-stim) within the same menstrual cycle, followed by in vitro fertilization (IVF) for independent reproduction after oocyte warming, resulting in a progressing clinical pregnancy.
Methods: Qualitative and descriptive case report study conducted at a private clinic specialized in Assisted Human Reproduction in Santo André, São Paulo, Brazil.
Results: V. R. F., 38 years old, sought fertility preservation at an assisted reproduction clinic after being diagnosed with a rare brain tumor – anaplastic oligodendroglioma (IDH mutant, WHO grade III, negative GFAP; mutated P53; Olig2 positive; preserved ATRX; focal SYN+; Ki-67: 30%). She underwent her first controlled ovarian stimulation cycle for oocyte vitrification using 225 IU/day of urinary gonadotropin (Menopur^®, Ferring) and 20 mg/day of dydrogesterone for pituitary suppression over 9 days. On day 10 of the cycle, triggering was performed with two ampoules of GnRH agonist (Gonapeptyl Daily^®, Ferring), followed by oocyte retrieval approximately 35 hours later of four dominant follicles. Five oocytes were retrieved: three were vitrified at the metaphase II (MII) stage, and two at prophase I (P1) were discarded. A double stimulation protocol was then proposed. The patient returned on day 5 after the first oocyte retrieval for a new controlled ovarian stimulation cycle, with an antral follicle count (AFC) of eight. She underwent 9 days of stimulation with 225 IU/day of urinary gonadotropin (Menopur^®, Ferring) and continued suppression with dydrogesterone 20 mg/day. Triggering occurred on the 10th day of stimulation with two ampoules of GnRH agonist (Gonapeptyl Daily^®, Ferring). The second oocyte retrieval was also performed about 35 hours after trigger, yielding six oocytes: three MII (vitrified), one MI (metaphase I), and two degenerated (discarded). The patient returned approximately 3.5 years later, having completed oncological treatment (chemotherapy and radiotherapy) and cleared by her oncologist for pregnancy. Now postmenopausal for three years, she expressed the desire for independent reproduction. Artificial endometrial preparation was initiated with 6 mg/day of oral estradiol (Primogyna), later increased to 8 mg/day. Luteal phase support was started once endometrial thickness reached 7.6 mm (trilinear pattern), using vaginal micronized progesterone (Utrogestan) 800 mg/day and oral dydrogesterone 20 mg/day for five full days, prior to fresh embryo transfer. Six oocytes frozen in 2019 were thawed for IVF with donor sperm, resulting in the formation of a single grade 1B blastocyst. One grade 1B blastocyst was transferred, resulting in a progressing intrauterine pregnancy without complications and a live birth by cesarean delivery at 39 weeks and 1 day: a female infant weighing 3,205 g at birth.
Conclusion: The DuoStim protocol and its adaptations, such as the bi-stim performed in this case, aim to retrieve a higher number of oocytes through double ovarian stimulation within the same menstrual cycle—an effective strategy for patients with time-sensitive fertility preservation needs. It is based on the theory of multiple follicular recruitment waves and aims for increased efficiency in patients with poor reproductive prognosis or urgency to begin oncological treatment. This case supports the consolidation of double ovarian stimulation in the same cycle as a modern and assertive strategy for ovarian stimulation in oncofertility settings, avoiding delays in cancer treatment. Furthermore, it demonstrates that this strategy can yield high-quality oocytes capable of resulting in healthy live births following warming and IVF.