The couple consulted with a history of primary infertility of 2 years.
She's 36 and her 37-year-old husband.
In the initial study, mild oligoasthesized spermia was found.
She also had anovulation secondary to polycystic ovary syndrome.
After attempting 4 cycles of superovulation with unsuccessful intrauterine insemination, it was decided to choose a cycle of high complexity in 2007, for which the couple gave their consent, after answering and solving all their doubts.
Controlled ovarian hyperstimulation
After suppressing the endogenous secretion of gonadotropin administration 10 mm, 0.5 mg of leuprolide acetate daily was administered for 7 days, as shown by ultrasound by the absence of follipofollic follicles of diameter ≥ 75 IU
On day 12 of stimulation, 22 follicles of ≥ 15 mm in diameter were observed, so 10,000 IU of HCG were indicated and 36 hours later, culdocentesis was performed under general anesthesia.
Considering the large number of follicles and the concentration of plasma estradiol (27,793.5 pg/ml), it was recommended to transfer embryos in a deferred way, in order to reduce the risk of developing ovarian hyperstimulation syndrome.
The patient presented a mild clinical picture, which resolved favorably with conservative measures, completely within two weeks.
Vitrification
The protocol used was published by Kuwa-yama in 20056.
According to this protocol, oocytes were gradually exposed to a equilibrium solution with 7.5% GE and 7.5% DMSO, followed by rapid exposure to saccharification solution and 0.5 M, with 15% GD, 15% DMSO.
After 1 minute of exposure to this solution, up to 2 oocytes were loaded in a container with 0.1 μl load volume and immersed quickly in liquid nitrogen.
Once inside the nitrogen, it was covered with a protective cap.
Finally, containers were placed in a storage tank with liquid nitrogen.
endometrial priming
Two months later, the endometrium was prepared for embryo transfer.
Preparation consisted of increasing administration of oral estradiol to achieve endometrial thickness under non-graphic ultrasonic 9 mm view. At this time 100 mg daily pro-gesterone was added.
The exogenous supplement of estradiol and progesterone lasted until completing the first trimester of pregnancy, when the placenta begins the synthesis in adequate quantity of these steroids.
Devitrification and transfer
Disvitation containers were transferred from the storage tank to a polystyrene box with liquid nitrogen.
Then the end was immersed for 1 minute in a thawing solution with sucrose 1.0 M at 37 °C. Then, oocytes were exposed for 3 minutes to a solution of sucrose 0.5 M for 2 minutes.
Finally, oocytes were transferred to a capsule with balanced culture medium and fixed until microinjection, 2 hours later.
The embryos obtained were cultured until their transfer, in a stage of eight cells, transvaginal with an ultrasonic catheter, under ultrasound vision.
