Live birth from ovarian grafted tissue following pelvic radiation for rectal cancer

Abstract

ObjectiveTo study the management of a woman who returned to conceive after high dose radiation treatment (RT), with documentation of uterine dosimetry, and the efficacy of ovarian tissue grafted into an irradiated pelvis. Design, setting, interventionA 26-year-old woman underwent RT to treat rectal cancer, with half of the uterus being exposed to a radiation dose of 50 Gy and 25 Gy to the fundus. We report details of the uterine assessment, determining suitability of conception with her own uterus, pregnancy surveillance and reproductive outcome. Main outcome measures, resultsThe results of MRI and pelvic ultrasound showed a small uterus with preserved junctional zone anatomy and while the endometrium was initially thin following administration of high oestrogen administration, endometrial thickness increased with time. Twelve grafted ovarian tissue stimulation cycles led to 4 embryo transfers, the last of which resulted in a live birth. She had two cervical cerclage procedures due to cervical shortening and delivered a 3.3kg healthy girl at 38/40 via LSCS. ConclusionsSuccessful pregnancy is possible from ovarian tissue grafted into an irradiated pelvis, with high dose uterine exposure. Careful uterine assessment needs to be undertaken to determine suitability of conception attempt with a patient’s own uterus, in consultation with the medical team. Further studies are needed to correlate imaging and biopsy findings with reproductive outcomes.