Live birth in a woman without ovaries after autograft of frozen-thawed ovarian tissue combined with growth factors

Abstract

Currently, cryopreservation of oocytes, embryos and ovarian tissue is considered the basis of fertility preservation programs for women with cancer and other diseases who are rendered sterile by gonadotoxic drugs or radiation.Numerous studies have confirmed that autograft of frozen-thawed ovarian tissue can restore ovarian function and fertility. A total of twenty-two live births have been reported but we still have to consider this technique as experimental. The main problem is that the implant undergoes ischemia until neoangiogenesis is restored, resulting in significant follicular loss.At the moment, there are numerous publications in different medical fields that publish successful experiences with plasma rich in platelets (PRP) in different clinical situations promoting angiogenesis. Thus, we considered the possibility of using it in the field of ovarian autologous transplantation in order to improve the vascularization of the implant and its quality. For this, both thawed ovarian tissue as practiced pockets on the rear side of the broad ligament which have been placed, have been impregnated with PRP. We can say that the implant treated in this way has had a rapid and successful response.We report a special interesting case because this is the first time that this technique is performed successfully in a woman without ovaries combined with growth factors to promote neoangiogenesis. Obviously, the results of the hormonal response come exclusively from the implanted tissue in these special conditions.

A Case Series on Platelet-Rich Plasma Revolutionary Management of Poor Responder Patients

“…In humans, PRP has been employed in an autologous ovarian transplantation in order to improve the vascularization and quality of the implant. The successful transplantation resulted in a live birth following COS [44].…”

Efficacy of ovarian tissue cryopreservation in a major European center

“…Obviously, pregnancies and live births [24,25] as well as living follicles identified after xenotransplantation [26] indicate that there must be (partial) follicle survival after cryopreservation/thawing according to the protocols of experienced centers. Nevertheless, it remains unknown from such data whether there is any room to improve these frequently used protocols in order to obtain higher pregnancy rates.…”

Platelet-rich plasma therapy and reproductive medicine

“…Isolated primordial or primary follicles from fresh or cryopreserved ovarian tissue cultured for 10 days in presence of PRP showed a significant greater growth rate and cell viability than follicles cultured in medium supplemented with fetal bovine serum. Also, the PRP in autografts of cryopreserved human ovarian tissue may have contributed to the successful pregnancy and birth after the first stimulation cycle in an oophorectomized patient, with undetectable level of AMH [33]. These last reports [32,33] emphasize the putative role of PRP growth factors on cell proliferation and neoangiogenesis promoting follicular survival and development.…”