Evaluation of the ovarian reserve in women transplanted with frozen and thawed ovarian cortical tissue

Capsule:
The follicle pool in transplanted frozen/thawed ovarian tissue is low compared with normal ovaries, and reduced follicular selection may explain these women’s poor reproductive outcomes in assisted reproduction.

Authors:
Tine Greve, M.D., Kirsten Tryde Schmidt, M.D., Ph.D., Stine Gry Kristensen, M.Sc., Erik Ernst, M.D., Ph.D., Claus Yding Andersen, D.M.Sc.
Volume 97, Issue 6 , Pages 1394-1398.e1, June 2012

Objective:
To investigate ovarian reserve and ovarian function in women transplanted with frozen/thawed ovarian tissue.

Design:
Retrospective cohort study.

Setting:
University hospital.

Patient(s):
18 women transplanted with their own frozen/thawed ovarian tissue.

Intervention(s):
None.

Main Outcome Measure(s):
Levels of antimüllerian hormone (AMH), duration of function of the transplanted ovarian tissue, outcome of assisted reproduction.

Result(s):
Of the 18 women who received transplanted ovarian tissue, levels of AMH were measured in 12 women; AMH never exceed a concentration of 1 ng/mL, and in several cases they were below the detection limit of the assay in combination with regular menstrual cycles. Two women with AMH below the detection limit conceived spontaneously. The duration of function of the transplants was between 9 months and 7 years and still functioning. Twelve women received assisted reproduction therapy; in 72 cycles, 65 oocytes were retrieved. The pregnancy rate and live-birth rate per cycle were 6.9% (5 of 72) and 2.8% (2 of 72), respectively.

Conclusion(s):
The relatively poor outcome of assisted reproduction in women transplanted with frozen/thawed ovarian tissue may reflect reduced follicular selection rather than defective or aged oocytes. In normal women, reduced follicular selection with age may be part of explaining the decline in female fecundity with increasing age.

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