Restoration of ovarian function after orthotopic (intraovarian and periovarian) transplantation of cryopreserved ovarian tissue in a woman treated by bone marrow transplantation for sickle cell anaemia: Case report

Abstract

Ovarian function after orthotopic transplantation of cryopreserved ovarian tissue has been restored in women with malignant disease. Here the techniques are adapted for a non-cancer patient. In 1999, right oophorectomy was performed in a 21 year old woman before chemotherapy, prior to bone marrow transplantation. Ovarian cortex was frozen, according to a strict protocol. After thawing, ovarian cortex was reimplanted into the ovary and in a peritoneal window close to the ovary in 2004. Four-and-a-half months after reimplantation, LH, FSH, 17beta-estradiol and progesterone levels, as well as ultrasonography, demonstrated the presence of an ovulatory cycle. After this cycle, the patient experienced two other ovulatory cycles, evidenced by FSH and 17beta-estradiol concentrations, as well as ultrasound demonstration of a follicle. Follicular development was clearly observed in both the intraovarian site (1st and 2nd cycle) and the peritoneal window (3rd cycle). Restoration of endocrine ovarian function occurred after ovarian cortical strips, biopsied and cryopreserved before chemotherapy, were reimplanted into the ovary itself and a periovarian peritoneal window.

VEGF and bFGF increase survival of xenografted human ovarian tissue in an experimental rabbit model

“…Israely et al [28] reported that implantation of ovarian graft into an angiogenic granulation tissue, created during wound healing, improved graft vascularization and follicular survival. Based on these results, this physiologic phenomenon was successfully applied for autotransplantation in women inducing new blood vessel formation by creating a peritoneal pocket or longitudinal opening of the ovary at the ovarian tissue transplantation sites 1 week before the transplantation [29,30].…”

Ovarian cryopreservation for fertility preservation: indications and outcomes

“…While overall fertility is preserved in the majority of women with SLE (Park et al 2004), they require variable treatment dosages over a more prolonged period than malignancies, adding to the difficulties of patient selection. Other appropriate conditions may include sickle cell disease where treatment with total body irradiation (TBI) is proposed (Donnez et al 2006a). The present data highlight the mortality associated with these non-malignant conditions.…”

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.…”

“…A maior difi culdade está no período pós-reimplante imediato, quando o risco de isquemia é maior e conseqüentemente há perda folicular irreversível 30 . Por isso a técnica de reimplante adotada parece ser o ponto principal, e alguns autores sugerem o uso de tiras de córtex reimplantados sobre o ovário atrófi co 23 , outros sugerem implantação subperitoneal na fossa ovárica através da criação de "bolsão" 25,26,31 , ou ainda do córtex ovariano inteiro sobre a medula residual 32 . Todos apresentam bons resultados, porém com pequenas casuísticas.…”