Oocyte Retrieval during Laparoscopic Vaginoplasty to Reduce Invasiveness in the Treatment of Mayer-Rokitansky-Küster-Hauser Syndrome

J Minim Invasive Gynecol. 2020 Jan;27(1):74-79. doi: 10.1016/j.jmig.2019.02.023. Epub 2019 May 23.

Abstract

Study objective: To evaluate the treatment of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with a combination of oocyte retrieval and surgical vaginoplasty in a single laparoscopic procedure.

Design: A case series.

Setting: The study was conducted at 2 tertiary referral facilities for MRKH syndrome in Milan, Italy, between July 2017 and September 2018.

Patients: Eleven patients presented with MRKH and required surgical vaginoplasty while expressing a desire for future fertility.

Interventions: Two experienced surgeons and an expert in assisted reproductive technology performed concomitant vaginoplasty according to the modified technique of Davydov and laparoscopic oocyte retrieval for gamete cryopreservation.

Measurements and main results: Before the procedure, patients underwent extensive counseling and gave written consent. At the start of surgery, 10.4 ± 4.4 (mean ± standard deviation [SD]) oocytes were retrieved laparoscopically, and 8.8 ± 3.1 (SD) mean mature oocytes were cryopreserved. After oocyte retrieval, the steps of the modified Davydov technique were followed. The total operative time was 116 ± 16 minutes (mean ± SD), and no intraoperative/postoperative complications were observed.

Conclusion: This is the first report of combined oocyte retrieval and vaginoplasty for patients with MRKH syndrome. The approach was found to be feasible in patients with a desire for future fertility. It is our belief that physicians treating patients with MRKH should refer patients to centers with expertise in both vaginoplasty and assisted reproductive technology.

Keywords: Assisted reproductive technology; Davydov technique; Gamete cryopreservation; Mayer-Rokitansky-Küster-Hauser syndrome.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • 46, XX Disorders of Sex Development / surgery
  • 46, XX Disorders of Sex Development / therapy*
  • Adolescent
  • Adult
  • Combined Modality Therapy
  • Congenital Abnormalities / surgery
  • Congenital Abnormalities / therapy*
  • Cryopreservation
  • Feasibility Studies
  • Female
  • Fertility Preservation / methods*
  • Follow-Up Studies
  • Gynecologic Surgical Procedures / methods*
  • Humans
  • Intraoperative Complications / etiology
  • Italy
  • Laparoscopy / methods*
  • Mullerian Ducts / abnormalities*
  • Mullerian Ducts / surgery
  • Oocyte Retrieval / methods*
  • Operative Time
  • Ovulation Induction / methods
  • Plastic Surgery Procedures / methods*
  • Postoperative Complications / etiology
  • Vagina / surgery*
  • Young Adult

Supplementary concepts

  • Mullerian aplasia