Full‐term newborn after repeated ovarian tissue transplants in a patient treated for Ewing sarcoma by sterilizing pelvic irradiation and chemotherapy

Abstract

We report the first successful transplantation of cryopreserved ovarian cortical tissue into heavily irradiated tissues in a patient who had received sterilizing pelvic radiotherapy (54 Gy) and 40 weeks of intensive high-dose chemotherapy for the treatment of Ewing’s sarcoma 14 years earlier. Repeated transplantation procedures were required to obtain fully functional follicular development. Enlargement of the transplants over time and increase of the size of the uterus were demonstrated on sequential ultrasonographic examinations. Eggs of good quality that could be fertilized in vitro were obtained only after a substantial incremental increase of the amount of ovarian tissue transplanted. Single embryo replacement resulted in a normal pregnancy and the birth of a healthy child by cesarean section at full-term. No neonatal or maternal postoperative complications occurred. Women facing high-dose pelvic radiotherapy should not be systematically excluded from fertility preservation options, as is currently the trend.

Ovarian cortex transplantation: 60 reported live births brings the success and worldwide expansion of the technique towards routine clinical practice

“…1 Data from a series of five women who underwent ovarian tissue cryopreservation before the age of 22 years (median 19 years) and before any kind of chemotherapy. Case 1-second orthotopic transplantation at 5 years (still functioning after 11 years), case 2-three pregnancies and deliveries (still functioning after 7 years), case 3-second orthotopic transplantation at 2 years; 1 pregnancy (egg donation) and delivery, case 4-two pregnancies and deliveries (still functioning after 5 years), and case 5-graft still functioning after 5 years Adapted from Fertil Steril [9], the Lancet [10], from two correspondences to the Lancet by Rozen et al [16], by Andersen [11], and from two publications by Rodriguez-Wallberg et al [17] and by Tanbo [18] SF slow freezing, VF vitrification a Twins b Personal communication and that by repeating the procedure, ovarian activity can be restored for more than 11 years. These encouraging results on ovarian function restoration now lead us to speculate that in the future, ovarian cortex cryopreservation at a young age, followed by reimplantation at menopause, could be an alternative to hormonal replacement therapy.…”

Ovarian regeneration: The potential for stem cell contribution in the postnatal ovary to sustained endocrine function

“…There are clinical case reports citing restoration of fertility in humans via ovarian tissue transplantation in which patients elected to have tissue removed and cryopreserved for grafting at a later date, or transplanted directly into a heterotrophic site (Oktay, 2001; Oktay et al, 2004). Multiple clinics have now reported restoration of ovarian function following ovarian tissue grafting, including a rise in serum estradiol concentrations and reduction in circulating FSH levels, occurring on average between 3.5 and 6.5 months post transplantation (Donnez et al, 2004, 2010, 2011; Macklon et al, 2014; Suzuki et al, 2015; Rodriguez-Wallberg et al, 2015; Oktay et al, 2016). Notably, in many instances the ovarian tissue grafts continue to function for several years following engraftment (Anderson et al, 2012).…”

An overview of pregnancy and fertility issues in breast cancer patients

“…During the last years reports of live births after such fertility preservation approach has increased and to date more than 20 women is reported to have given birth after ovarian tissue transplantation including a woman exposed to pelvic radiotherapy (42,43). Despite the fast development of these techniques they are still considered to be experimental (44).…”