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Case Reports
. 2019 May 14;19(1):65.
doi: 10.1186/s12905-019-0764-8.

A case report and follow-up of the first live birth after heterotopic transplantation of cryopreserved ovarian tissue in Eastern Europe

Triin Tammiste  1   2 , Keiu Kask  3 , Peeter Padrik  4   5 , Külli Idla  1 , Karin Rosenstein  6 , Tatjana Jatsenko  7 , Piret Veerus  1 , Andres Salumets  8   9   10   11
Affiliations
Case Reports

A case report and follow-up of the first live birth after heterotopic transplantation of cryopreserved ovarian tissue in Eastern Europe

Triin Tammiste et al. BMC Womens Health. .

Abstract

Background: Ovarian insufficiency is a major concern for long-term cancer survivors. Although semen freezing is well established to preserve male fertility, the possibilities to secure post-cancer female fertility are mostly limited to oocyte or embryo freezing. These methods require time-consuming ovarian stimulation with or without in vitro fertilization (IVF) that evidently delays cancer therapy. Ovarian tissue cryopreservation and subsequent thawed tissue autotransplantation are considered the most promising alternative strategy for restoring the fertility of oncology patients, which has not yet received the full clinical acceptance. Therefore, all successful cases are needed to prove its reliability and safety.

Case presentation: Here we report a single case in Estonia, where a 28-year-old woman with malignant breast neoplasm had ovarian cortex cryopreserved before commencing gonadotoxic chemo- and radiotherapy. Two years after cancer therapy, the patient underwent heterotopic ovarian tissue transplantation into the lateral pelvic wall. The folliculogenesis was stimulated in the transplanted tissue by exogenous follicle-stimulating hormone and oocytes were collected under ultrasound guidance for IVF and embryo transfer. The healthy boy was born after full-term gestation in 2014, first in Eastern Europe.

Conclusion: Despite many countries have reported the first implementation of the ovarian tissue freezing and transplantation protocols, the data is still limited on the effectiveness of heterotopic ovarian transplant techniques. Thus, all case reports of heterotopic ovarian tissue transplantation and long-term follow-ups to describe the children's health are valuable source of clinical experience.

Keywords: Case report; Fertility preservation; Heterotopic transplantation; Live birth; Ovarian tissue cryopreservation; Restoration of gonadal function.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Timescale of the patient’s medical history from the diagnosis of the cancer to the successful live birth. A 28-year-old woman with invasive ductal G3 carcinoma had ovarian cortex cryopreserved before commencing gonadotoxic chemo- and radiotherapy. Two years after cancer therapy, the patient underwent heterotopic ovarian tissue transplantation into the lateral pelvic wall. The folliculogenesis was stimulated in the transplanted tissue by exogenous follicle-stimulating hormone and oocytes were collected under ultrasound guidance for IVF and embryo transfer. The healthy boy was born after full-term gestation, first in Eastern Europe
Fig. 2
Fig. 2
Schematic view of the fertility preservation procedures. Based on the patient’s clinical conditions the heterotopic ovarian tissue transplantation was the only option to restore her fertility after 25 months of cancer diagnosis. (1) 5 pieces of thawed ovarian tissue were transplanted to the submuscular pocket on the left side of the lateral pelvic wall and marked with a metallic marker for better ultrasound visibility. (2) The folliculogenesis was stimulated in the transplanted tissue by using exogenous follicle-stimulating hormone. (3) The oocytes were collected under ultrasound guidance from the grafted tissue (near the metallic marker) only for subsequent (4) IVF and (5) embryo transfer. No follicles were punctured from the ovaries, thus excluding the chance for the spontaneous pregnancy
Fig. 3
Fig. 3
First live births after cryopreserved ovarian tissue transplantation to cancer survivors in European countries. By 2014, live births after cryopreserved ovarian tissue transplantation have been reported in majority of the Western European countries, while Eastern European countries reported this later than Estonia. Abbreviation: OG ongoing pregnancy. *FertiProtekt cooperation of ca 100 institutions in Germany, Austria and Switzerland
See this image and copyright information in PMC

References

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