Transplantations of frozen thawed ovarian tissue demonstrate high reproductive performance and the need to revise restrictive criteria

Patients undergoing ovarian tissue cryopreservation, with or without chemotherapy exposure, demonstrate autotransplantation yields high reproductive performance, resulting in both spontaneous and in vitro fertilization pregnancies.

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Volume 106, Issue 2, Pages 467-474

Authors:

Dror Meirow, M.D., Hila Ra'anani, M.D., Moran Shapira, M.D., Masha Brenghausen, Ph.D., Sanaz Derech Chaim, B.Sc., Sarit Aviel-Ronen, M.D., Ph.D., Ninette Amariglio, Ph.D., Eyal Schiff, M.D., Raoul Orvieto, M.D., Jehoshua Dor, M.D.

Abstract:

Objective

To report the single-center results of orthotopic retransplantations of cryopreserved ovarian tissue in cancer survivors and evaluate the validity of commonly accepted procedure limitations.

Design

Prospective cohort study.

Setting

Tertiary university-affiliated assisted reproduction technology (ART) and oncology centers.

Patient(s)

Twenty cancer survivors who underwent ovarian transplantation of frozen-thawed ovarian tissue with the aim to conceive.

Intervention(s)

Ovarian tissue cryopreservation (OTCP) and transplantation, endocrine monitoring, in vitro fertilization (IVF).

Main Outcome Measure(s)

Endocrine profile, IVF, pregnancies, live births.

Result(s)

The patient ages at tissue harvesting ranged from 14 to 39 years. Fifteen women had hematologic malignancies, and two had leukemia (chronic myelogenous leukemia and acute myelogenous leukemia). Ten patients were exposed to nonsterilizing chemotherapy before OTCP. After transplantation, the endocrine recovery rate was 93%. Fourteen patients underwent IVF treatments with a fertilization rate of 58%. Sixteen pregnancies were achieved (10 after IVF, 6 spontaneous), resulting in 10 live births, two (twins) after harvesting from the mother at the age of 37. Two pregnancies are currently ongoing. After transplantation, 53% of patients conceived, and 32% delivered at least once. One patient conceived four times. Preharversting chemotherapy exposure was not associated with inferior outcomes. All patients, including two leukemia survivors, remained cancer free.

Conclusion(s)

Orthotopic transplantation of thawed ovarian tissue is a highly effective measure to restore fertility in sterilized cancer patients. Chemotherapy exposure before harvesting and age >35 is a realistic option in selected patients. Retransplantation in leukemic patients is possible after application of maximal safety measures. These results have led the national ethical and professional authorities to decide for the first time not to consider OTCP as an experimental modality for fertility preservation.

Clinical Trial Registration Number

NCT02659592.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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