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BACKGROUND Ovarian tissue cryopreservation involves freezing and storing of surgically retrieved ovarian tissue in liquid or vapour nitrogen below –190°C. The tissue can be thawed and transplanted back with the aim of restoring fertility or ovarian endocrine function. The techniques for human ovarian tissue freezing and transplantation have evolved over the last 20 years, particularly in the context of fertility preservation in pre-pubertal cancer patients. Fresh ovarian tissue transplantation, using an autograft or donor tissue, is a more recent development; it has the potential to preserve fertility and hormonal function in women who have their ovaries removed for benign gynaecological conditions. The techniques of ovarian tissue cryopreservation and transplantation have progressed rapidly since inception; however, the evidence on the success of this intervention is largely based on case reports and case series. OBJECTIVE AND RATIONALE The aim of this study was to systematically review the current evidence by incorporating study-level and individual patient-level meta-analyses of women who received ovarian transplants, including frozen–thawed transplant, fresh or donor graft. SEARCH METHODS The review protocol was registered with PROSPERO (CRD42018115233). A comprehensive literature search was performed using MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials from database inception to October 2020. Authors were also contacted for individual patient data if relevant outcomes were not reported in the published manuscripts. Meta-analysis was performed using inverse-variance weighting to calculate summary estimates using a fixed-effects model. OUTCOMES The review included 87 studies (735 women). Twenty studies reported on ≥5 cases of ovarian transplants and were included in the meta-analysis (568 women). Fertility outcomes included pregnancy, live birth and miscarriage rates, and endocrine outcomes included oestrogen, FSH and LH levels. The pooled rates were 37% (95% CI: 32–43%) for pregnancy, 28% (95% CI: 24–34%) for live birth and 37% (95% CI: 30–46%) for miscarriage following frozen ovarian tissue transplantation. Pooled mean for pre-transplant oestrogen was 101.6 pmol/l (95% CI: 47.9–155.3), which increased post-transplant to 522.4 pmol/l (95% CI: 315.4–729; mean difference: 228.24; 95% CI: 180.5–276). Pooled mean of pre-transplant FSH was 66.4 IU/l (95% CI: 52.8–84), which decreased post-transplant to 14.1 IU/l (95% CI: 10.9–17.3; mean difference 61.8; 95% CI: 57–66.6). The median time to return of FSH to a value <25 IU/l was 19 weeks (interquartile range: 15–26 weeks; range: 0.4–208 weeks). The median duration of graft function was 2.5 years (interquartile range: 1.4–3.4 years; range: 0.7–5 years). The analysis demonstrated that ovarian tissue cryopreservation and transplantation could restore reproductive and hormonal functions in women. Further studies with larger samples of well-characterized populations are required to define the optimal retrieval, cryopreservation and transplantation processes. WIDER IMPLICATIONS Ovarian tissue cryopreservation and transplantation may not only be effective in restoring fertility but also the return of reproductive endocrine function. Although this technology was developed as a fertility preservation option, it may have the scope to be considered for endocrine function preservation.

Objective: To evaluate ovarian stimulation regimens and reproductive outcomes in a cohort of women undergoing ovarian tissue cryopreservation (OTC) and ovarian tissue transplantation (OTT). Design: Retrospective cohort study. Setting: University hospital and fertility clinics. Patients: Twenty-eight women undergoing OTT and in vitro fertilization (IVF) from 2012 to 2017. Intervention: OTC, OTT, and IVF. Main Outcome Measures: Ovarian stimulation and IVF outcomes. Results: In total, 99 cycles were performed in 28 patients. In 19 patients responding to stimulation, a median of 3.0 cycles per patient (range: 1-14 cycles) was performed, and 2.0 mature oocytes were retrieved per cycle. The empty follicle rate was 35.9%. Eleven women achieved 15 pregnancies, of which 60% were lost during the first or second trimester, resulting in 5 of 28 women having R1 live births, and seven healthy children being born. In breast cancer patients (mean age at OTC: 33.0 years), the pregnancy rates (PR) and live birth rates (LBR) were 35.0% and 5.0% per embryo transfer, respectively. Patients aged R34.5 years at OTC all had breast cancer and did not achieve any pregnancies. For all other diagnoses (mean age at OTC: 26.6 years), PR and LBR were 50.0% and 37.5% per embryo transfer, respectively. Collectively, 39% of patients conceived at least once, and 17.9% delivered. Frozen-thawed embryo transfer (FET) resulted in more pregnancies than did fresh embryo transfer. Conclusion: Our results suggest that women of advanced maternal age undergoing OTC and IVF have a poor ovarian reserve, resulting in a poor reproductive outcome. Interestingly, FET appeared to be superior to fresh transfer. (Fertil Steril Ò 2020;114:379-87. Ó2020 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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The REC scoring system identified or ruled out most ECs, clearly showing that more specific image analysis at first-line TVS can accelerate the diagnosis of EC in patients with PMB and may allow for improved selection of second-line strategies in patients with ET ≥4 mm.