A SINGLE-CENTER EXPERIENCE OF OVARIAN TISSUE TRANSPLANTATION IN 15 PATIENTS

Abstract

Objective

Ovarian tissue cryopreservation (OTC) and transplantation has become a promising option for fertility preservation in women facing the risk of premature ovarian failure. We aim to report our experience with 15 patients who underwent frozen thawed ovarian tissue transplantation (OTT).

Methods

This retrospective cohort study included 15 women who underwent OTT in our tertiary referral center between December 2011 and June 2024. All the patients had previously undergone OTC using a slow freezing protocol with a home-made pre-prepared freezing medium including DMSO and sucrose. All patients diagnosed with acute leukemia had received consolidation chemotherapy prior to OTC before undergoing bone marrow transplantation (BMT). A medical clearance was obtained from each patient's hematologist-oncologist, and a vial of tissue was thawed to screen for the presence of residual leukemic cells. All OTT procedures were performed laparoscopically, with the ovarian cortical fragments being transplanted either into a retroperitoneal pocket (n=11), created 2 days earlier to enhance vascularization, or directly onto the menopausal ovary (n=1), or both(3).

Results

All 15 patients who underwent OTT regained ovarian function, as demonstrated by decreased FSH levels, increased estradiol and resumption of menstruation. Patient characteristics are shown in Table 1. No major surgical complications or adverse events were observed. The median age at OTC and OTT were 23.31± 7.9 years and 32.6 ± 1.48 years respectively. The indications were as follows; leukemia (n= 6), lymphoma (n=5), breast cancer (n=1), pineal gland tumor (n=1), thalassemia (n=1), and aplastic anemia (n=1). Mean serum AMH before OTC and following OTT was 1.37± and 0.16±0.11, respectively. Following IVF, 8 healthy live births occurred in 6 patients (Two of them was twin), summing up a pregnancy rate of 45.46% per patient (5/11) in those undergoing IVF (Patient 15 does not included). In one patient diagnosed with acute leukemia, IVF resulted in a healthy ongoing pregnancy following second OTT, and in another patient diagnosed with acute leukemia 2 euploid blastocysts were frozen in the first ovarian stimulation cycle (patient 14). In patient 15, who had 2 previous IVF cancellation due to POR, a healthy live birth occurred from the menopausal ovary following retroperitoneal OTT. Except one patient who underwent OTT very recently, no relapse was recorded in 5 patients with acute leukemia over a mean follow-up >50 months. Graft survival was > 24 months in all patients.

Conclusion

Transplantation of frozen thawed ovarian tissue remains a promising and established technique for fertility preservation, with prolonged graft longevity and increased pregnancy rates. We suggest that OTT may be feasible in carefully screened leukemia survivors following BMT.