Re-implantation of cryopreserved ovarian cortex resulting in restoration of ovarian function, natural conception and successful pregnancy after haematopoietic stem cell transplantation for Wilms tumour

Abstract

With the improvement of long-term cancer survival rates, growing numbers of female survivors are suffering from treatment-related premature ovarian insufficiency (POI). Although pre-treatment embryo and oocyte storage are effective fertility preservation strategies, they are not possible for pre-pubertal girls or women who cannot delay treatment. In these cases, the only available treatment option is ovarian cortex cryopreservation and subsequent re-implantation. A 32-year-old woman had ovarian cortex cryopreserved 10 years previously before commencing high-dose chemotherapy and undergoing a haematopoietic stem cell transplant for recurrent adult Wilms tumour, which resulted in POI. She underwent laparoscopic orthotopic transplantation of cryopreserved ovarian cortex to the original site of biopsy on the left ovary. She ovulated at 15 and 29 weeks post-re-implantation with AMH detectable, then rising, from 21 weeks, and conceived naturally following the second ovulation. The pregnancy was uncomplicated and a healthy male infant was born by elective Caesarean section at 36+4 weeks gestation. This is the first report of ovarian cortex re-implantation in the UK. Despite the patient receiving low-risk chemotherapy prior to cryopreservation and the prolonged tissue storage duration, the re-implantation resulted in rapid restoration of ovarian function and natural conception with successful pregnancy.

86 successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: focus on birth and perinatal outcome in 40 of these children

“…An overview of the perinatal outcome of children conceived in women who have had frozen-thawed ovarian tissue transplanted available from peer-reviewed papers, including nine new Danish cases, is given in Tables 2 [13,, 3, and 4. Table 2 provides detailed information on the deliveries from published peer-reviewed journals including information on the woman (diagnosis, age at cryopreservation and signs of menopause before transplantation, time from transplantation Oktay et al [13] S F N A 1 Meirow et al [14] SF NA* 4 (+2) The Nordic countries [15] and this publication SF (Sweden VF) 14 7(+2)** FertiPROTEKT network [16] SF 54*** 11 Dunlop et al [17] S F N A 1…”

Fertility Preservation for Pediatric and Adolescent Patients With Cancer: Medical and Ethical Considerations

“…75,76 In adults, more than 70 live births have been reported in women who cryopreserved ovarian tissue, but only when the tissue was harvested postpubertally. [77][78][79][80][81][82] A potential confounder in the various case series in which live births were reported is that in the majority of cases, some native ovarian tissue was present in addition to the autotransplanted ovarian tissue. It is possible that pregnancies occurred from oocytes obtained from the native ovarian tissue and not from the transplanted material.…”

Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity

“…According to data from published research, since the first pregnancy was reported using this technique in 2004, the number of live births after ovarian tissue slow freezing and orthotopic auto-transplantation has exceeded 120 [ 13 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 ]. According to data from five major centers, the pregnancy and live birth rates were 29% and 23%, respectively [ 108 ].…”