Ovarian function and spontaneous pregnancy after combined heterotopic and orthotopic cryopreserved ovarian tissue transplantation in a patient previously treated with bone marrow transplantation: Case Report

Abstract

Cryopreservation of ovarian tissue has been proposed for storing gametes of young patients at high risk of premature ovarian failure. Autotransplantation has recently provided some promising results and is still the unique option to restore ovarian function from cryopreserved ovarian tissue in humans. In this article, we analyse data from the combined orthotopic and heterotopic transplantation of cryopreserved ovarian tissue that restored the ovarian function and fertility. Orthotopic transplantation of cryopreserved ovarian tissue at ovarian and peritoneal sites, together with a heterotopic transplantation at the abdominal subcutaneous site, was performed to restore the ovarian function of a 29-year-old woman previously treated with bone marrow transplantation (BMT) for Hodgkin's disease. Ovarian reserve markers progressively suppress within values 5 months after the transplantation (basal FSH 5 mUI/ml and inhibin B 119 ng/ml). Follicular development was observed at all transplantation sites but was predominant at the ovarian site. Six natural cycles were fully documented and analysed. The patient became spontaneously pregnant following the sixth cycle, but unfortunately she later miscarried. Combined orthotopic and heterotopic transplantations succeeded in the restoration of normal spontaneous cycles. Furthermore, this spontaneous pregnancy confirmed the efficiency of this procedure for restoring human fertility.

Detection of Non-Hodgkin’s Lymphoma in ovarian cortex pieces during the process of cryopreservation

“…Few experimental studies have tested the human ovarian tissue from both HL or NHL and failed to show evidence of ovarian involvement by lymphoma cells [18,20,24,25]. To date, 15 auto-transplantations have been reported in HL patients and 6 in NHL without any disease recurrence, knowing that the follow-up after autotransplantation in one of the HL patients is now up to 8 years [19,[26][27][28][29][30][31][32][33][34]. Nevertheless, a recent case-report showed an ovarian involvement in the histologic examination of ovarian cortex pieces in a stage III HL [15].…”

Challenges and pitfalls in prenatal screening in pregnancies involving allogeneic stem cell transplantation recipients

“…Options included cryopreservation of sperms, oozytes, 8 pre-fertilized embryos or even gonadal tissues. 9 For HSCT recipients failing natural conception, the use of in vitro fertilization (IVF) or even intracytoplasmic sperm injection, 10 using concentrated/ cryopreserved/donor sperm and oocytes may be considered. The use of IVF allows earlier dating and monitoring of pregnancy.…”

Preservação de fertilidade

“…O restabelecimento de função ovariana pós-reimplante de tecido ovariano congelado-descongelado já foi descrito por alguns autores [23][24][25] , inclusive com nascimento de criança sadia após falência ovariana pós-quimioterapia comprovada, seja por gestação espontânea 26,27 ou por técnicas de reprodução assistida 28 . A conservação do tecido em si a partir de técnicas de congelamento não é tão complicada.…”