Retransplantation of cryopreserved ovarian tissue: the first live birth in Germany

Abstract

Background: Cryopreserved ovarian tissue can be retransplanted to restore fertility after radiation or chemotherapy. To date, 15 live births after retransplantation have been reported worldwide. We report the first pregnancy and the first live birth after retransplantation in Germany.

Case report: A 25-year-old female patient received initial chemotherapy and radiation of the mediastinum for Hodgkin's lymphoma in 2003 and suffered a relapse two years later. Ovarian tissue was laparoscopically removed and cryopreserved, and she was then treated with high-dose chemotherapy and stem cell transplantation. She remained in remission for 5 years and she could not conceive during this time. The cryopreserved ovarian tissue was thawed and laparoscopically retransplanted into a peritoneal pouch in the ovarian fossa of the right pelvic wall. Three months later, her menopausal symptoms resolved, and she had her first spontaneous menstruation. Six months after retransplantation, after two normal menstrual cycles, low-dose follicle stimulating hormone (FSH) treatment induced the appearance of a dominant follicle in the tissue graft. Ovulation was then induced with human chorionic gonadotropin (HCG), whereupon the patient conceived naturally. After an uncomplicated pregnancy, she bore a healthy child by Caesarean section on 10 October 2011. Histological examination of biopsy specimens revealed that the ovarian tissue of the graft contained follicles in various stages of development, while the original ovaries contained only structures without any reproductive potential.

Conclusion: This was the first live birth after retransplantation of cryopreserved ovarian tissue in Germany and also the first case with histological confirmation that the oocyte from which the patient conceived could only have come from the retransplanted tissue. In general, young women who will be undergoing chemotherapy and/or radiotherapy for cancer must be informed and counseled about the available options for fertility preservation.

Figure 1

Laparoscopic retransplantation of ovarian tissue in a peritoneal pouch of the ovarian fossa on the right abdominal wall near the hilum of the ovary (1, ureter; 2, lateral umbilical ligament; 3, infundibulopelvic ligament; 4, fallopian tube; 5, uterus)

Figure 2

Dominant follicle in the area of the transplant at the time of triggered ovulation

Figure 3

Intraoperative view during cesarean section, showing residual right ovary: the right fallopian tube is being held up, revealing a crescent-shaped strand of tissue in place of the ovary

Figure 4

Intraoperative view during cesarean section, showing retransplanted material on the right abdominal wall; small follicles are clearly seen in the area of the transplant, and ventrally a distinct venous complex in the right broad ligament

Figure 5

Biopsy sample obtained from transplant during cesarean section, showing an intact secondary follicle with nucleus (hematoxylin-eosin staining, magnification 40×)