Fertility Preservation: Successful Transplantation of Cryopreserved Ovarian Tissue in a Young Patient Previously Treated for Hodgkin's Disease

Abstract

After completing this course, the reader will be able to:1. Discuss recent advances in the use of cryopreserved ovarian tissue to restore fertility.2. Explain the main aspects of the procedure for transplantation of cryopreserved ovarian tissue.3. Discuss the options to preserve fertility of young patients with a high risk for premature ovarian failure after cancer therapy.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTCryopreservation of ovarian tissue is now offered as an experimental procedure to preserve the fertility of young patients with a high risk for premature ovarian failure resulting from cancer therapy. This is the only available option to preserve the fertility of prepubertal patients treated with gonadotoxic chemotherapy. At present, thousands of patients all over the world have undergone this procedure with the hope of later restoring their fertility. Although the efficiency of the transplantation of cryopreserved ovarian tissue to restore ovarian function has been established, reports of pregnancy are still very scarce. Here, we describe the second published full-term spontaneous pregnancy after an orthotopic and heterotopic transplantation of cryopreserved ovarian tissue in a 31-year-old woman previously treated by conditioning therapy for bone marrow transplantation for Hodgkin's disease. This birth gives compelling evidence for the graft origin of the gamete and confirms the efficacy of ovarian tissue transplantation in restoring human natural fertility after oncological treatment. This case report stresses the importance of proposing the ovarian tissue cryopreservation procedure to all young patients who require potentially sterilizing treatment, with all alternative options to preserve fertility being duly taken into consideration.

Ovarian cryopreservation for fertility preservation: indications and outcomes

“…Initial human experience with reimplantation of ovarian tissue demonstrated some hormonal function but without ovulation (Oktay & Karlikaya 2000 and, more recently, successful conception has been reported after orthotopic reimplantation in women with Hodgkin's and non-Hodgkin's lymphoma and Ewing's sarcoma (Donnez et al 2004, Demeestere et al 2007, Andersen et al 2008). There are currently published reports of five babies delivered following reimplantation of cryopreserved ovarian tissue (Table 1).…”

“…Case reports in humans initially indicated the possibility of some restoration of follicular activity (Oktay & Karlikaya 2000 but subsequently live birth after orthotopic reimplantation (Donnez et al 2004, Demeestere et al 2007, Andersen et al 2008) and embryo development after heterotopic implantation and IVF Lee et al 2006) emphasising its experimental nature and uncertain outcome. All aspects of this approach remain unclear: appropriate indications, the methods to be used surgically and in the laboratory both at the time of cryopreservation and later usage, and the potential risks that may in the case of reimplantation include reintroduction of the original disease.…”

Successful in vitro culture of pre-antral follicles derived from vitrified murine ovarian tissue: oocyte maturation, fertilization, and live births

“…Ovarian tissue grafting techniques have been used to restore ovarian function after cryopreservation, and live births have been reported after transplantation of cryopreserved ovarian tissues in animals (Gosden et al 1994, Salle et al 2003, Wang et al 2009) and humans (Donnez et al 2004, Meirow et al 2005, Demeestere et al 2007, Andersen et al 2008, Silber et al 2008, Sánchez-Serrano et al 2010. However, extensive follicular damage and subsequent fibrosis are commonly observed after transplantation (Kim et al 2002), and autotransplantation procedures have the added risk of transferring malignant cells back to the patient (Kim et al 2001).…”

Detection of Non-Hodgkin’s Lymphoma in ovarian cortex pieces during the process of cryopreservation

“…Few experimental studies have tested the human ovarian tissue from both HL or NHL and failed to show evidence of ovarian involvement by lymphoma cells [18,20,24,25]. To date, 15 auto-transplantations have been reported in HL patients and 6 in NHL without any disease recurrence, knowing that the follow-up after autotransplantation in one of the HL patients is now up to 8 years [19,[26][27][28][29][30][31][32][33][34]. Nevertheless, a recent case-report showed an ovarian involvement in the histologic examination of ovarian cortex pieces in a stage III HL [15].…”