Live birth after transplantation of frozen-thawed ovarian tissue after bilateral oophorectomy for benign disease

doi:10.1016/j.fertnstert.2012.05.017

Fertility and Sterility

Volume 98, Issue 3, September 2012, Pages 720-725

https://doi.org/10.1016/j.fertnstert.2012.05.017 Get rights and content

Objective

To report the restoration of ovarian function and pregnancy in a woman after bilateral oophorectomy for benign disease after autotransplantation of cryopreserved ovarian cortex.

Design

Case report.

Setting

Gynecology research unit in a university hospital.

Patient(s)

A 28-year-old woman who underwent bilateral adnexectomy for ovarian abscesses at the age of 18 years.

Intervention(s)

We performed ovarian cortex autotransplantation to a peritoneal pocket in the broad ligament.

Main Outcome Measure(s)

Restoration of ovarian activity and pregnancy.

Result(s)

Restoration of ovarian function began at 20 weeks and was achieved 24 weeks after transplantation. After the fifth stimulation attempt, two mature oocytes were obtained and microinjected. One embryo (seven cells) was obtained and transferred, leading to a normal pregnancy. The patient delivered a healthy baby boy weighing 2,370 g at 38 weeks of gestation.

Conclusion(s)

Ovarian cortex cryopreservation can be performed at the time of surgery for benign diseases when fertility is impaired. We report the first pregnancy to occur after ovarian tissue cryopreservation for benign ovarian pathology after bilateral oophorectomy.

Section snippets

Materials and methods

In December 2001, the patient, who was 18 years of age at the time, underwent laparoscopy followed by midline laparotomy for peritonitis, appendectomy, and partial resection of the cecum. In February 2002, she developed clinical features of PID that resolved with antibiotic therapy. In June 2002, laparotomy was carried out for recurrent PID. Because of the presence of large 10-cm in diameter tubo-ovarian abscesses, bilateral salpingo-oophorectomy was carried out. Owing to extensive inflammation

Ovarian Biopsy after Cryopreservation

Histological examination of a sample of cryopreserved ovarian tissue thawed at the time of transplantation revealed the presence of 12 primordial follicles/mm².

Ovarian Activity (Fig. 2)

The patient continued HT for 8 weeks after surgery. Twelve weeks later (thus 20 weeks after transplantation), vaginal ultrasound revealed the presence of a follicle of 6 mm in the transplantation area. The E₂ level was 19 pg/mL and FSH had significantly decreased to 25.6 mIU/mL.

Four weeks later (24 weeks post-transplantation), vaginal

Discussion

This paper reports the first pregnancy to occur after bilateral oophorectomy and ovarian cortex cryopreservation and grafting for benign ovarian pathology (bilateral recurrent abscesses on probable endometriomas). Fertility may indeed be decreased by radical surgery in case of torsion of benign cysts like dermoids or by extensive surgery for endometriomas. Several papers have shown reduced anti-Müllerian hormone levels, a sign of decreased ovarian reserve, after ovarian cystectomy for

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Ovarian function return, the number of oocytes/embryos, aneuploidy %, live births, and neonatal outcomes were recorded. Graft longevity was compared with the mean from the meta-analytic data.
Ovarian function returned 13.9 ± 2.7 weeks (11–16.2 weeks) after ACOTT, and oocytes were retrieved in all cases with 12.3 ± 6.9 embryos generated. In contrast to orthotopic, the heterotopic ACOTT demonstrated low embryo quality and an 80% aneuploidy rate. A recipient did not attempt to conceive and 2 needed a surrogate, whereas 4 of 4 delivered 6 healthy children, compared with 115 of 460 (25% pregnancy rate) from the meta-analytic data (n = 79). The mean graft longevity (43.2 ± 23.6/47.4 ± 22.8 months with/without sensitivity analysis) trended longer than the meta-analytic mean (29.4 ± 22.7), even after matching age at cryopreservation.
In this series, RA-ACOTT resulted in extended graft longevity, with ovarian functions restored in all cases, even when the tissues were cryopreserved after chemotherapy exposure.
Trasplante ovárico con cirugía robótica y una matriz extracelular humana de neovascularización: una serie de casos en comparación con datos meta-analíticos.
Reportar nuestra experiencia con trasplante de tejido ovárico autólogo criopreservado (ACOTT) asistido por robot (RA) con el uso de una matriz extracelular estructurada de neovascularización.
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Académico.
Siete receptoras de RA-ACOTT.
Antes e inmediatamente después de iniciar quimioterapia, el tejido ovárico fue criopreservado en 7 mujeres que fueron sometidas a RA-ACOTT 9.9 ± 1.8 años (rango 7-12 años) después. En el periodo perioperatorio, recibieron estrógenos transdérmicos y aspirina a bajas dosis para favorecer la vascularización del injerto. Segmentos de corteza ovárica fueron descongelados y suturados en una matriz extracelular estructurada, la cual posteriormente fue anastomosada robóticamente al ovario remanente en 6 casos y retroperitonealmente (heterotópico) en el abdomen inferior en un caso.
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: J.D. has nothing to disclose. P.J. has nothing to disclose. C.P. has nothing to disclose. G.H. has nothing to disclose. D.D. has nothing to disclose. J.S. has nothing to disclose. J.S. has nothing to disclose. M.-M.D. has nothing to disclose.

: J.D. and P.J. contributed equally to this article.

: This work was supported by grants from the Fonds National de la Recherche Scientifique de Belgique (grant nos. 3.4590.08F and 7.4507.10), the Foundation Against Cancer (Belgium), and the Fondation Saint-Luc and donations from A Frère, Ph. de Spoelberch, and P. Ferrero.

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Original articleLive birth after transplantation of frozen-thawed ovarian tissue after bilateral oophorectomy for benign disease

Objective

Design

Setting

Patient(s)

Intervention(s)

Main Outcome Measure(s)

Result(s)

Conclusion(s)

Section snippets

Materials and methods

Ovarian Biopsy after Cryopreservation

Ovarian Activity (Fig. 2)

Discussion

Int J Radiat Oncol Biol Phys

Lancet Oncol

Best Pract Res Clin Obstet Gynecol

Lancet

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Lancet

RBM Online

Reprod Biomed Online

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Original article
Live birth after transplantation of frozen-thawed ovarian tissue after bilateral oophorectomy for benign disease