Ovarian cortex freezing as a method of fertility preservation in endometriosis: A case report

BACKGROUND: Endometriosis affects women in many ways from infertility until reducing ovarian reserve. In women who do not want to immediately conceive, ovarium cortex cryopreservation may be an option for preserving fertility. CASE PRESENTATION: Two patients with chief complaints dysmenorrhea and abdominal enlargement, then checked Anti-Mullerian Hormone (AMH) level and Ca-125 level. Patient underwent transrectal ultrasonography, with the result of endometriosis cyst (sized 12 × 9x3 cm and 7 × 10 × 11 cm for first patient, while second patient had 18 × 10 × 14 cm). Then patients underwent cystectomy and ovarian cryopreservation. Histopathology results revealed endometriosis cyst, with different results of follicle density on the healthy cortex. Patient have an AMH level of 1.82 ng/mL before surgery and may decline after surgery. From the AMH normogram, the patient is below the 25th percentile and almost below the 10th percentile, and her biological age is 34. Normal histopathology result of the ovarian cortex suggested that 1.8 to 166 follicles per mm(3) cortical tissue. DISCUSSION: We can see from the histopathology examination the density of the follicle was less than normal in this patient. Patients that suffer from endometriosis may have a low ovarian reserve even before surgery. A thorough consultation, followed by ovarian reserve evaluation, disease progression and recurrence of disease are needed to be monitored closely. CONCLUSION: From all the methods of fertility preservation, we concluded that this patient is most suitable for ovarian cortex freezing.