Ovarian response to gonadotrophins, optimal method for oocyte retrieval and pregnancy outcome in patients with vaginal agenesis

The aim of this study is to characterize the ovarian response to stimulatio n and the optimal method of oocyte retrieval in patients with vaginal agene sis (Mayer-Rokitansky-Kuster-Hauser syndrome) in a gestational carrier prog ramme. Twelve patients underwent gonadotrophin stimulation and hormonal mon itoring. Forty-nine treatment cycles were initiated; seven cycles were canc elled secondary to poor stimulation, Five patients had undergone surgical n eovagina construction; seven patients had utilized vaginal dilators. Oocyte retrieval was achieved in one cycle via transvesical ultrasound, in two cy cles via transabdominal ultrasound, in nine cycles via laparoscopy and in 3 0 cycles via transvaginal ultrasound. Ten pregnancies were achieved which i ncluded two clinical pregnancies, two biochemical pregnancies, three single ton births and three sets of twin births. A live birth rate of 45.5% was ac hieved per patient. Hormonal response to gonadotrophin stimulation in this population was similar to that of patients with normal pelvic anatomy. Preg nancy outcome was comparable to other patients utilizing gestational carrie rs within the same program (i.e. surgically absent uterus, anatomically non -functioning uterus, etc.). The surgical creation of a neovagina makes tran svaginal retrieval technically more difficult than when dealing with a dila tor-created vagina, and may require laparoscopy or transabdominal ultrasoun d for oocyte retrieval.