Longevity of autologous ovarian transplants: extended experience in humans

Abstract

OBJECTIVE: Currently no data are available on the long-term survival of autologous ovarian transplants (AOT). We performed this study to report on the extended experience of the oldest AOT program. DESIGN: A prospective follow up study of women who underwent AOT. MATERIALS AND METHODS: Between 1999 and 2008, we performed 5 AOTs with frozen banked (n=3) and fresh (n=2) ovarian tissue. Indications and patient characteristics are shown in table 1.Table 1Case NoYear of TransplantationIndication for Fertility PreservationAge at FreezingAge at TransplantationDuration of BankingType of Transplantation11999Probable Endometriosis28298 monthsOrthotopic (Pelvic sidewall)21999Cervical CancerFresh35N/AHeterotopic (s.c. forearm)32001Benign Ovarian CystFresh37N/AHeterotopic (s.c. forearm)42004Breast Cancer313772 monthsHeterotopic (s.c. lower abdomen)52005Hodgkin Lymphoma262929 monthsHeterotopic (s.c. lower abdomen) Open table in a new tab RESULTS: In all 5 cases, ovarian function returned within 3 months. In cases 1, 2, 4, and 5, ovarian stimulation was performed. Cases 2 and 4 underwent oocyte retrieval yielding GV or M-I oocytes, which had to be in vitro matured. From case 4, a 4-cell embryo was obtained but did not result in pregnancy. Same patient was also unable to conceive with two different egg donors, demonstrating poor embryo development. Because her partner was, due to past-chemotherapy, severely oligospermic, there was suspicion of a male etiology for poor embryo quality. Patient-5 spontaneously conceived twice, simultaneously with two consecutive ovulations from the heterotopic AOT and delivered a healthy child 3 years ago. The same patient recently underwent ovarian stimulation and percutaneous oocyte retrieval, resulting in retrieval of a M-II oocyte, which did not fertilize. Two months later the patient's FSH reached menopausal range. This was, however, the first case, where a mature oocyte was obtained from a frozen-banked AOT, placed into a subcutaneous location. In patients 1, 3, and 5, the graft function ceased 9, 17, and 41 months after AOT. Interestingly in patient 3, follicle development and menstruation returned 12 months later. Patient 2 experienced local cancer recurrence and, unfortunately, died 22 months after transplant while the graft was still functioning. In patient 4, the graft continues to function for > 4 years. CONCLUSIONS: AOT results in restoration of hormonal function in all cases. Longevity of the grafts is variable but appears to be shortened in comparison to in situ ovaries.