Evaluation of ovarian tissue transplantation: results from three clinical centers

Abstract

Objective: To report ovarian tissue autotransplantation (AT) results and describe the relationship between technical and clinical factors and outcomes.

Design: Multicenter retrospective cohort study.

Setting: Tertiary medical centers.

Patient(s): Infertile patients who had stored ovarian tissue before sterilizing treatment and returned for AT with the aim of conceiving.

Interventions(s): Ovarian tissue cryopreservation (OTC) and AT, endocrine monitoring, in vitro fertilization.

Main outcome measure(s): Endocrine performance, pregnancy and live-birth rates.

Result(s): From 2004 to 2018, 70 patients underwent 87 ATs. Sixty patients undergoing 70 ATs met the inclusion criteria. After AT, menses returned in 94% of patients and median FSH dropped from 68 to 19 IU/mL. Fifty pregnancies and 44 deliveries were attained, with 50% of women achieving at least one pregnancy and 41.6% at least one delivery. Twelve patients underwent AT more than once and had their endocrine activity restored in case menses recurred after the first transplantation. Repeated transplantations yielded five live births in three patients, two of whom had already given birth after the first transplantation. Preharvesting chemotherapy was not associated with inferior outcomes. Of seven patients whose pelvis was exposed to radiation before AT, four conceived and delivered. Neither tissue dimensions nor surgical approach affected fertility outcomes.

Conclusion(s): OTC is highly effective at restoring fertility in sterilized patients, and prior exposure to chemotherapy should not be considered a contraindication. Repeated AT should be contemplated in case of graft malfunction, especially if previous transplantation was successful. In selected cases, conception and delivery may be feasible after pelvic exposure to radiation.

Keywords: Ovarian autotransplantation; cancer; fertility preservation; ovarian cryopreservation.