Abstract
Ovarian cryopreservation followed by auto-transplantation has recently been removed from the experimental category for fertility preservation (FP) by the ASRM. However, the current success rates of this FP approach are unknown. Therefore, we sought to perform a meta-analysis with the use of individual patient data, where available, to determine the success rates of autologous cryopreserved ovarian tissue transplantation (ACOTT) with previously cryopreserved tissue. Meta-analysis was performed by reviewing data from 2000, when the first ACOTT procedure was reported, to March 2021. Additional cases were retrieved from meeting abstracts and own database with 7 cases. We selected studies that reported ACOTTs with previously banked tissue in humans. We did not include any cases involving fresh ovarian tissue transplantation or those performed to treat idiopathic premature ovarian failure/insufficiency. Both authors reviewed and selected studies for eligibility, which resulted in 89 full-text studies assessed for eligibility. Cases were extracted from original reports and reviews by the junior author, and the senior author reviewed and verified the extracted data. 42 reports were included for qualitative synthesis. The age at ovarian cryopreservation was reported in 206 women and the mean is 29.26 years (range: 9-40 years, SD: 5.36) with women undergoing the first ACOTT at the mean age of 32.52 (data available in 177 cases, range: 13-45 years, SD: 5.31). In 11 new studies and personal correspondence with authors, detailed data were available to determine live birth plus ongoing (LB + OG) pregnancy and in 12 new studies to calculate endocrine restoration rate. 322 new ACOTTs were performed in 263 new patients, resulting in the birth of 63 children and 11 OG pregnancies. Current cumulative LB+OG pregnancy rate is 26,9%. Since 20002, 518 women had undergone 631 ACOTTs, what resulted in 141 LB plus 11 OG pregnancies (145 singleton and 7 twin pregnancies, respectively) and 148 babies were born. To calculate ovarian activity recovery rate, we identified 315 patients where the information about endocrine function after ACOTT was available. Among those, 241 (76.50%) regained ovarian function with mean graft longevity of 34.49±25.63 months (range: 0-144). ACOTT is a successful procedure for ovarian function restoration, however, there is a need for further improvement in pregnancy rates and longevity.
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