Reproductive outcomes after in vitro fertilization treatment in a cohort of Danish women transplanted with cryopreserved ovarian tissue

Abstract

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.

A Systematic Review of Ovarian Tissue Transplantation Outcomes by Ovarian Tissue Processing Size for Cryopreservation

“…The clinical metadata for participants that were included in this systematic review is detailed in Supplementary Table 4 . A total of 92 unique participants who underwent OTT after OTC with the goal of having a biological child or restoring hormones were included in this analysis ( 21 , 22 , 25 , 34 , 37 , 44 , 57 , 59 , 61 , 64 , 66 , 78 , 84 , 91 – 93 , 95 , 111 , 115 , 118 , 124 ). Overall, 51, 37, and 4 participants had their ovarian tissue processed into strips, squares, and fragments, respectively ( Table 3 ).…”

“… Participant diagnosis at time of OTC in (A) overall patient population (B) strips (C) squares and (D) fragments group. Diagnoses in the other category included the following in ( 1 ) overall: acute lymphocytic leukemia, adnexal mass with left adnexectomy, aplastic anemia, autoimmune vasculitis, choriocarcinoma, colorectal cancer, endometrial cancer, granulomatosis with polyangiitis, leukemia, neuroendocrine tumor, ovarian cancer, Schwachman-diamond syndrome, sickle cell anemia, synovial sarcoma of the lung and pelvic sarcoma, systemic lupus erythematosus, T-cell lymphoma ( 2 ), strips: acute lymphocytic leukemia, aplastic anemia, β-thalassemia, colorectal cancer, endometrial cancer, rectal cancer, Schwachman-diamond syndrome, sickle cell anemia, systemic lupus erythematosus, and ( 3 ) squares: autoimmune vasculitis, β-thalassemia, choriocarcinoma, Ewing’s sarcoma, granulomatosis with polyangiitis, leukemia, myelodysplastic syndrome, neuroendocrine tumor, non-Hodgkin’s lymphoma, ovarian cancer, rectal cancer, synovial sarcoma of the lung and pelvic sarcoma, T-cell lymphoma ( 21 , 22 , 25 , 34 , 37 , 44 , 57 , 59 , 61 , 64 , 66 , 78 , 84 , 91 – 93 , 95 , 111 , 115 , 118 , 124 ). …”

Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting

“…The use of letrozole to suppress supra-physiologic estrogens can be used safely without a reduction in the number or quality of oocytes. OTC is a widespread FP option, which is already considered standard in several countries [87]. It does not require COS, allowing FP in an urgent setting (e.g., when chemotherapy should be started as soon as possible) [88].…”

“…It does not require COS, allowing FP in an urgent setting (e.g., when chemotherapy should be started as soon as possible) [88]. The ovarian cortical tissue is retrieved through laparoscopy, cryopreserved, and then re-transplanted into the ovary enabling the woman to search for a pregnancy spontaneously or through IVF [87,89]. Literature reports live birth rates around 30-40% in experienced centers [87,89,90].…”

“…The ovarian cortical tissue is retrieved through laparoscopy, cryopreserved, and then re-transplanted into the ovary enabling the woman to search for a pregnancy spontaneously or through IVF [87,89]. Literature reports live birth rates around 30-40% in experienced centers [87,89,90]. Two live births after OTC and retransplantation are reported in BRCA-mutated early BC patients [52,91].…”