Abstract
IntroductionThe likelihood of survival after cancer treatment among young women with cancer has increased considerably, quality of life after treatment has drawn more attention. However, in young fertile women, fertility preservation is an important issue with regard to quality of life. One of the options of fertility preservation is ovarian tissue cryopreservation. The purpose of this follow‐up study is to present our clinical experiences and evaluate the long‐term follow up of ovarian cryopreservation to improve future patient selection.Material and methodsFrom July 2002 to December 2015 at the Leiden University Hospital, the Netherlands, 69 young women underwent ovarian tissue cryopreservation when they were at risk of iatrogenic premature ovarian insufficiency. Follow‐up data with regard to ovarian function were obtained until October 2018, from medical records and questionnaires.ResultsOf the 69 women in whom ovarian tissue cryopreservation was performed, 12 died (15.9%), 57 were approached to participate, of which 6 were lost to follow up. The indications for ovarian tissue cryopreservation were malignant (81.1%) and benign (18.9%) diseases in which gonadotoxic treatment was scheduled. In total, twenty women (39.2%) are known to have premature ovarian insufficiency due to gonadotoxic treatment. Fifteen women conceived spontaneously, and delivered 25 babies. In this cohort, the usage rate of autotransplantation is 8.7% (7/69). In total, nine autotransplantations of cryopreserved ovarian tissue were performed in seven patients (of which 1 ovarian tissue cryopreservation was performed in another hospital) after which 6 babies were born to four women, giving a live‐birth rate of 57%.ConclusionsOvarian tissue cryopreservation followed by autotransplantation is an effective method to restore fertility (live‐birth rate of 57%). The usage rate of 8.7% (6/69) indicates that more knowledge about the risk of premature ovarian insufficiency after gonadotoxic treatment is needed to be able to offer ovarian tissue cryopreservation more selectively.
Highlights
The likelihood of survival after cancer treatment among young women with cancer has increased considerably, quality of life after treatment has drawn more attention
Abbreviation: IVF, in vitro fertilization; OTC, ovarian tissue cryopreservation. aThese women underwent 2 autotransplantation procedures. bPatient recruitment and ovarian cryopreservation were performed in another hospital
When looking at our results, not all women actively wish for a child and a large number of women in our cohort are still at risk of developing premature failure later in life: resumption of cyclic menses after high gonadotoxic treatment does not guarantee normal fertility.[41]
Summary
Improved cancer treatment has resulted in decreased overall cancer mortality rates. From 1991 to 2006, overall cancer death rates decreased by 12.3%. As a result of the increasing emphasis on fertility issues of young survivors, ovarian tissue cryopreservation (OTC) has been developed as 1 of the options to preserve fertility in case of gonadotoxic treatment. Over the last 2 decades, OTC has developed from the first successful report of a live birth in sheep, to the resumption of follicular activity and menstrual cycles after orthotopic autotransplantation in humans described by Oktay and Karlikaya Since this technique has resulted in more than 130 healthy infants.[4,5,6,7]. We present the first study in the Netherlands, concerning the follow up and clinical experiences of women undergoing OTC and autotransplantation
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