Department of Obstetrics & Gynecology, Hospital Saint Joseph, FranceFulltext PDF
Background: We report the first case of meningioma dramatically revealed during endometriosis indicated IVF treatment. This 5 cm large meningioma in a 32 years old woman provoked general convulsive crisis, and a brachial deficit member. Any hormonal treatment or pregnancies are now contraindicated to this young woman. This case aware our ART team, and raises many questions. Do ART specialists have to establish a meningioma screening strategy before ART? Who to screen? If a meningioma is diagnosed, do we have to prohibit ART to the patient?
The National Agency of Medication Security (ANSM) published in 2021 use restrictions and screening recommendations concerning Chlormadinone Acetate (ACM) and Normegestrol (NMG), after those of 2018 concerning the use of cyproterone acetate (PCA), faced with the risk of developing meningiomas. Due to the pathologies responsible for their infertility, patients treated with ART are likely to have been exposed to these molecules.
Objective: To assess the practices of ART professionals in patients who have been treated with ACM/NMG/PCA and to identify a preventive course of action before ART in these patients at risk of developing a meningioma.
Material and Methods: We sent a multiple-choice inquiry by email, via our professional associations, to French ART specialists. 123 anonymous responses were analyzed; 39% worked in a private hospital, 37% in a public hospital, and 23.6% in a city office; 80% had more than 5 years of senior ART activity.
Results: 61% did not check in patient inquiry a prior use of PCA, ACM or NMG before ART. After previous exposure to these molecules, 26% were unaware of the exposure time after which a brain MRI should be offered. 25% retained the indication for imaging after 24 months of treatment, compared to 21.9% after 12 months and 10% after 6 months.
Concerning the minimum gap between the end of these treatments and an ART: 84.1% estimated it at 6 months, 8.4% at 12 months and 6% between 18 and 24 months.
Conclusions: Faced with the heterogeneity of the results, we propose to systematically search during medical inquiry:
Prior exposure to ACM, PCA or NMG. If exposure is confirmed for more than 2 years: Realize a brain MRI to rule out a contraindication to ART.
A minimum period of 6 months between the end of the treatment and the start of ART should be observed.
A history of meningioma under progestogen. If necessary, we recommend performing an MRI and discussing the file in a multidisciplinary consultation meeting before authorizing any treatment in ART.
Khaiat A. In Vitro Fertilization Revealing Intracranial Meningioma: Case Report and Online Enquiry Among French ART
Specialists: Who and When to Screen?. Ann Infert Rep Endocrin. 2022, 5(1):1027..