Pregnancies and live births after 20 transplantations of cryopreserved ovarian tissue in a single center

Capsule:
Preserving fertility by cryopreserving ovarian tissue is a successful and safe clinical option that can be considered for selected cancer patients.

Authors:
Ralf Dittrich, Ph.D., Janina Hackl, M.D., Laura Lotz, M.D., Inge Hoffmann, M.D., Matthias W. Beckmann, M.D.

Volume 103, Issue 2, Pages 462-468

Abstract:

Objective:
To report the results of 20 orthotopic retransplantations of cryopreserved ovarian tissue after cancer treatment.

Design:
Retrospective analysis.

Setting:
Tertiary gynecology department.

Patient(s):
Twenty patients with malignant disease: 11 with hematological malignancies (55%), four with breast cancer (20%), three with anal cancer (15%), and two with ovarian cancer (10%); the mean age before oncological treatment was 30.5 years.

Intervention(s):
Ovarian tissue was removed from patients in various centers in Germany in 2005–2009. All patients received chemotherapy and/or radiotherapy. Afterward, 17 patients had complete premature ovarian insufficiency, while three still showed some ovarian activity. Overnight transportation of tissue before freezing was necessary in eight cases. Cryopreservation followed slow freezing protocols in all cases. Retransplantation was performed at Erlangen University Hospital 3.75 years after extraction, on average. Thawed tissue was transplanted into a peritoneal pouch in the broad ligament region, below the tube, in 16 cases. Fragments were sutured both onto the remaining ovary and into a peritoneal pouch in four cases.

Main Outcome Measure(s):
Restoration of ovarian activity, pregnancy, birth.

Result(s):
Ovarian activity resumed in all patients except one. Seven patients conceived, with one miscarriage and four ongoing pregnancies. Four patients delivered healthy babies. One pregnancy and live birth after oocyte donation need to be considered separately.

Conclusion(s):
These data clearly demonstrate that preserving fertility by cryopreserving ovarian tissue is a successful and safe clinical option that can be considered for selected cancer patients.

  • Genia Rozen

    We read with interest Dittrich R et al’s experience with ovarian tissue transplantation. In their discussion they report the “published lived births following
    transplantation” but have omitted the two live births from our centre Stern et al, 2013.

    This technique is gaining importance as a successful option for preserving fertility, however there is still uncertainly about its overall efficiency with a general lack of
    reporting of the total number of grafting procedures performed. In our centre we have performed 18 grafting procedures in 14 patients, with 21 embryos transferred, 2 pregnancies and a clinical pregnancy rate of 14%.

    While this technique may be regarded as a successful option to preserve fertility it requires optimisation and the first step towards this goal is to gain an accurate representation of worldwide clinical outcomes, with individual centres accurately reporting their results.

    Rozen G
    Agresta F
    Gook D
    Braat DD
    Stern CJ

    Referenes

    1. Dittrich R, Hackl J, Lotz L, Hoffmann I, Beckmann MW. Pregnancies and live births after 20 transplantations of cryopreserved ovarian tissue in a single center. Fertil Steril. 2015 Feb;103(2):462-86.

    2. Stern CJ, Gook D, Hale LG, Agresta F, Oldham J, Rozen G, Jobling T. First reported clinical pregnancy following heterotopic grafting of cryopreserved ovarian tissue in a woman after a bilateral oophorectomy. Hum Reprod. 2013 Nov;28(11):2996-9

    3. Stoop D, Cobo A, Silber S. Fertility preservation for age-related fertility decline. Lancet 2014 Oct 4;384(9950):1311-9.

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