Fertility Preservation: The Challenge of Freezing and Transplanting Ovarian Tissue

Dolmans, Marie-Madeleine; Donnez, Jacques; Cacciottola, Luciana

doi:10.1016/j.molmed.2020.11.003

Cited by 79 publications

(56 citation statements)

References 158 publications

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“…Ovarian tissue cryopreservation (OTC) and the transplantation of frozen/thawed ovarian tissue (OTT) have proven to be valid methods for fertility preservation in women who have experienced iatrogenic-induced follicle loss or who have a genetic disease that leads to premature follicle loss [1][2][3][4][5][6][7]. Only the pool of small nongrowing follicles that are located in the cortex remain viable after freezing and thawing, and the technique focuses on the growth and development of surviving, nongrowing follicles upon transplantation [2][3][4]. Therefore, transplanted women require 4 to 6 months for nongrowing follicles to reach the preovulatory stage, in which they secrete substantial amounts of sex steroids and harbour an oocyte that has the potential to support further development.…”

Section: Introductionmentioning

confidence: 99%

Hormonal response in patients transplanted with cryopreserved ovarian tissue is independent of whether freezing was performed in childhood or adulthood

Hornshøj

Dueholm

Mamsen

et al. 2021

J Assist Reprod Genet

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Purpose This study evaluated the concentrations of hormones resulting from the transplantation of ovarian tissue (OTT) in relation to whether the tissue was frozen at a time close to puberty or above the age of 19 years. Methods Six girls and adolescents (aged 9-14 years) who underwent ovarian tissue cryopreservation (OTC) were followed after transplantation in adulthood. After OTT, the women were followed via regular blood samples to evaluate the concentrations of FSH, LH, oestradiol and AMH. Twenty-three women undergoing OTT (aged 19-36 years at the time of OTC) were included as a reference group. All of the women had postmenopausal levels of gonadotropins at the time of transplantation. ResultsThe return of FSH and LH to normal premenopausal concentrations in adult women transplanted with ovarian tissue that was frozen at a time close to puberty was similar to the profiles in women from the reference group. Serum AMH levels were below the detection limit (via the Roche Elecsys assay) in many samples, but four out of six young girls showed measurable concentrations. Oestradiol similarly increased in the first 12 weeks following transplantation, after which it tended to be higher in women having frozen tissue in adulthood. Conclusions Ovarian tissue that was excised from girls at a time close to puberty, after which it was frozen and transplanted in adulthood, interacts with pituitary tissue in a similar manner to ovarian tissue that is frozen from adult women. Follicles located in the ovarian tissue from young girls are equally sensitive to gonadotropin stimulation as follicles from adult women when exposed to postmenopausal levels of gonadotropins. This result indicates that it is not the ovaries that require maturation to sustain full reproductive potential but rather proper FSH and LH stimulation. Moreover, these results support the continued use of OTC in young women.

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Section: Introductionmentioning

confidence: 99%

Hormonal response in patients transplanted with cryopreserved ovarian tissue is independent of whether freezing was performed in childhood or adulthood

Hornshøj

Dueholm

Mamsen

et al. 2021

J Assist Reprod Genet

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“…und mit Beginn der Menarche lediglich ca. 500.000 Follikel, von denen ungefähr 400-500 zur Ovulation gelangen würden, je nachdem, wie viele Schwangerschaften und Laktationsphasen beziehungsweise ovulationshemmende Medikamente die zyklische Eizellreifung unterbrechen würden [4]. Die reproduktive Lebensphase einer Frau endet jedoch nicht erst mit der völligen Entleerung des Follikelpools mit der Menopause, sondern bereits früher, wenn die Befruchtungsfähigkeit und das Entwicklungspotenzial der Eizellen nachlassen [5].…”

Section: Ovarielle Reserveunclassified

“…In Österreich ist die Entnahme und Kryokonservierung von Samenzellen, Eizellen, Embryonen und auch Eier-stockgewebe nur bei medizinischer Indikation, also drohendem Funktionsverlust der Keimzellen, zulässig [30] [40]. Die erste Schwangerschaft nach erfolgreicher Retransplantation wurde bereits 2004 publiziert [41], und seither sind es weltweit geschätzt mehr als 220 Geburten nach Retransplantation von Ovarialgewebe [4].…”

Section: Fertilitätsprotektive Maßnahmenunclassified

Fertilität – Mythos und Realität

Wölfler

2021

J. Klin. Endokrinol. Stoffw.

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ZusammenfassungObwohl die Lebenserwartung des Menschen in den letzten Jahrhunderten drastisch zugenommen hat, bleibt die Fertilität stark altersabhängig und auf das biologische Zeitfenster der reproduktiven Lebensphase beschränkt. In den letzten Jahrzehnten zeichnet sich ein deutlicher Trend der Verschiebung der Familienplanung in die späte reproduktive Lebensphase ab mit der Konsequenz, dass die Voraussetzungen für eine Spontankonzeption und einen unkomplizierten Schwangerschaftsverlauf mit steigendem maternalem Alter stark reduziert sind. Aufklärung über diese Zusammenhänge und eine Verbesserung der „fertility awareness“ sind unbedingt erstrebenswert, um die Wahrscheinlichkeit für unerfüllten Kinderwunsch zu reduzieren.Fertilitätsstörungen sind häufig, über alle Altersgruppen gemittelt ist ungefähr jedes sechste Paar mit Kinderwunsch davon betroffen. Bei Fertilitätsstörungen sind frühzeitige Diagnostik und Ausschöpfen der Behandlungsoptionen von zentraler Bedeutung, da der Faktor Zeit – sei es durch die zunehmende Sterilitätsdauer oder zunehmendes Alter – jeweils mit der Abnahme der Wahrscheinlichkeit für die Geburt eines Kindes assoziiert ist. Mittels reproduktionsmedizinischer Maßnahmen können viele Fertilitätsstörungen erfolgreich behandelt werden, der Faktor maternales Alter kann jedoch nicht ausgeglichen, sondern gegebenenfalls nur mithilfe einer Eizellspende behoben werden. Bei drohendem frühzeitigem Verlust der Ovarialfunktion stehen darüber hinaus fertilitätsprotektive Maßnahmen im Rahmen mittlerweile gut etablierter Methoden zur Verfügung.

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“…Furthermore, the large number of nongrowing follicles in the cortex enhances the possibility of a successful outcome. However, the conditions that facilitate freezing of ovarian tissue do not necessarily coincide with conditions that best sustain the survival of follicles in connection with ovarian tissue transplantation (OTT) [4,5]. The tissue is transplanted (often in the remaining postmenopausal ovary) without reanastomosis, leaving the tissue without a proper supply of oxygen and nutrients for the first period after grafting.…”

Section: Introductionmentioning

confidence: 99%

Hormonal Characteristics of Women Receiving Ovarian Tissue Transplantation with or without Endogenous Ovarian Activity

Greve

Dueholm

Mamsen

et al. 2021

JCM

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Ovarian tissue cryopreservation (OTC) and transplantation of frozen/thawed ovarian tissue (OTT) are used for fertility preservation in girls and women. Here, we evaluated the hormonal characteristics of women with or without postmenopausal levels of FSH at the time of OTT to study differences and conditions that best support the initiation of ovarian function. A total of 74 women undergoing OTT (n = 51 with menopausal levels of FSH; n = 23 with premenopausal levels) were followed by measurements of FSH, LH, AMH, and oestradiol. Concentrations of FSH and LH returned to premenopausal levels after 20 weeks on average, with a concomitant increase in oestradiol. Despite resumption of ovarian activity, AMH concentrations were in most instances below the detection limit in the menopausal group, suggesting a low ovarian reserve. Despite a higher age in the premenopausal group, they more often experienced an AMH increase than the menopausal group, suggesting that conditions in the premenopausal ovary better sustain follicle survival, perhaps due to the higher concentrations of oestradiol. Collectively, this study highlights the need for improving follicle survival after OTT. Age and the amount of tissue transplanted are important factors that influence the ability to regain ovarian activity and levels of FSH may need to be downregulated and oestradiol increased prior to OTT.

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Fertility Preservation: The Challenge of Freezing and Transplanting Ovarian Tissue

Cited by 79 publications

References 158 publications

Hormonal response in patients transplanted with cryopreserved ovarian tissue is independent of whether freezing was performed in childhood or adulthood

Hormonal response in patients transplanted with cryopreserved ovarian tissue is independent of whether freezing was performed in childhood or adulthood

Fertilität – Mythos und Realität

Hormonal Characteristics of Women Receiving Ovarian Tissue Transplantation with or without Endogenous Ovarian Activity

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