Oocyte donation in women cured of cancer with bone marrow transplantation including total body irradiation in adolescence

Abstract

Female survivors of cancer in childhood and adolescence who have been treated with bone marrow transplantation including total body irradiation (TBI) are at high risk of developing ovarian follicular depletion and infertility. The lack of oocytes may be compensated for by oocyte donation but these patients also seem to have a uterine factor. Even though oestrogen replacement therapy is given, the growth of the uterus during adolescence is impaired. To our knowledge there have been no earlier reports of live births after oocyte donation in such patients. We report three cases of oocyte donation in women who, at a young age, were cured of haematological malignancies with bone marrow transplantation including TBI. In adolescence they developed ovarian failure and uterine volumes were assessed by ultrasonography. One woman with a uterus of almost normal size delivered a healthy child in the 37th week of gestation. Another woman with severely diminished uterine volume miscarried in the 17th week of gestation. The third woman has not yet conceived. Pregnancy achieved by oocyte donation is possible despite TBI in adolescence. However, the uterine factor is a concern and complications during pregnancy and preterm birth may be expected in these patients.

Impact of Cancer Therapy on the Reproductive Axis

“…Uterine blood flow was impaired, and these observations have serious implications for possible fertility after oocyte donation in these women [52, 55, 56]. …”

Prevention of Osteoporosis and Hypogonadism by Allogeneic Ovarian Transplantation in Conjunction With Intra-Bone Marrow–Bone Marrow Transplantation

“…Allogeneic bone marrow transplantation (BMT) has commonly been recommended in the treatment of children with relapsed or very high-risk leukemias and lymphomas today: the 10-year-survival rate after BMT is close to 50% (1). As the population of transplant recipients has grown, new challenges have arisen in the management of long-term complications of transplantation.…”

Endometrial receptivity after oocyte donation in recipients with a history of chemotherapy and/or radiotherapy

“…They found a cycle success rate of 37% and an implantation rate of 17%. Larsen et al (2000) reported three cases of OD in women cured of cancer by bone marrow transplantation, including TBI. One woman delivered a healthy child in the 37th week of gestation, another woman miscarried in the 17th week of gestation and the third had not yet conceived.…”