Successful conception in a 34-year-old lupus patient following spontaneous pregnancy after autotransplantation of cryopreserved ovarian tissue

Abstract

Premature gonadal failure is a common problem in patients with systemic lupus erythematosus (SLE) when gonadotoxic therapies are applied. The preservation of gonadal function and fertility is of great importance to many predominantly young SLE patients. Some fertility preservation methods are well established and well known, whereas others are considered more cautiously. In particular, the cryopreservation of ovarian tissue is a rarely chosen fertility preservation option for SLE patients of (pre)fertile age. We report the first case of successful conception and pregnancy of an SLE patient after autotransplantation of cryopreserved ovarian tissue. A 26-year-old SLE patient decided to undergo cryopreservation of ovarian tissue when receiving cyclophosphamide for lupus nephritis. Tissue removal, preparation, cryopreservation and quality control was performed, as described, according to current state-of-the-art techniques. After 6 years of being in remission using azathioprine and belimumab, her ovarian tissue was autotransplanted because of premature ovarian failure, diagnosed at the age of 32, and a wish to conceive. She conceived spontaneously 8 months later, having a diamniotic-dichoriotic twin pregnancy. The children were born prematurely due to preterm premature rupture of membranes in the 32nd week of gestation; mother and children are doing very well 8 months later. We regard the procedure to be an option worth consideration for our predominantly young SLE patients.

A Systematic Review of Ovarian Tissue Transplantation Outcomes by Ovarian Tissue Processing Size for Cryopreservation

“…The clinical metadata for participants that were included in this systematic review is detailed in Supplementary Table 4 . A total of 92 unique participants who underwent OTT after OTC with the goal of having a biological child or restoring hormones were included in this analysis ( 21 , 22 , 25 , 34 , 37 , 44 , 57 , 59 , 61 , 64 , 66 , 78 , 84 , 91 – 93 , 95 , 111 , 115 , 118 , 124 ). Overall, 51, 37, and 4 participants had their ovarian tissue processed into strips, squares, and fragments, respectively ( Table 3 ).…”

“… Participant diagnosis at time of OTC in (A) overall patient population (B) strips (C) squares and (D) fragments group. Diagnoses in the other category included the following in ( 1 ) overall: acute lymphocytic leukemia, adnexal mass with left adnexectomy, aplastic anemia, autoimmune vasculitis, choriocarcinoma, colorectal cancer, endometrial cancer, granulomatosis with polyangiitis, leukemia, neuroendocrine tumor, ovarian cancer, Schwachman-diamond syndrome, sickle cell anemia, synovial sarcoma of the lung and pelvic sarcoma, systemic lupus erythematosus, T-cell lymphoma ( 2 ), strips: acute lymphocytic leukemia, aplastic anemia, β-thalassemia, colorectal cancer, endometrial cancer, rectal cancer, Schwachman-diamond syndrome, sickle cell anemia, systemic lupus erythematosus, and ( 3 ) squares: autoimmune vasculitis, β-thalassemia, choriocarcinoma, Ewing’s sarcoma, granulomatosis with polyangiitis, leukemia, myelodysplastic syndrome, neuroendocrine tumor, non-Hodgkin’s lymphoma, ovarian cancer, rectal cancer, synovial sarcoma of the lung and pelvic sarcoma, T-cell lymphoma ( 21 , 22 , 25 , 34 , 37 , 44 , 57 , 59 , 61 , 64 , 66 , 78 , 84 , 91 – 93 , 95 , 111 , 115 , 118 , 124 ). …”

“… Age of participant at OTC (A) and OTT (B) in different size cryopreserved and transplanted ovarian tissue. P-values greater than 0.05 were considered not significantly different (ns) ( 21 , 22 , 25 , 34 , 37 , 44 , 57 , 59 , 61 , 64 , 66 , 78 , 84 , 91 – 93 , 95 , 111 , 115 , 118 , 124 ). …”

“…P-values greater than 0.05 were considered not significantly different (ns) P-values greater than 0.05 were considered not significantly different (ns).P-values less than 0.05 (*) and 0.005(**) were considered significantly different. ( 21 , 22 , 25 , 34 , 37 , 44 , 57 , 59 , 61 , 64 , 66 , 78 , 84 , 91 – 93 , 95 , 111 , 115 , 118 , 124 ).…”

“…52.2% (48/92) of all participants who were reported to undergo OTT were also monitored for pregnancy attempts using assisted reproductive technologies (ART) or spontaneously ( 21 , 22 , 25 , 34 , 37 , 44 , 57 , 59 , 61 , 64 , 66 , 78 , 84 , 91 – 93 , 95 , 111 , 115 , 118 , 124 ). A total of 16, 11 and 3 participants with strip, square, and fragment ovarian tissue pieces attempted pregnancy ( Table 4 ).…”