Ovary transplantation results: fresh vs frozen

Abstract

OBJECTIVE: Ovarian tissue cryobanking to preserve fertility has been performed worldwide for over a decade, but until recently there was no way to assess the efficacy of this strategy for achieving healthy babies. A series of cases of premature ovarian failure (POF) at one center using the same microsurgical techniques for both fresh and frozen transplants, provided this opportunity. DESIGN: Consecutive series of women with premature ovarian failure (POF) who underwent either fresh (9), or frozen (3) ovarian transplantation. MATERIALS AND METHODS: Ten women with ovarian failure were recipients of 12 ovarian tissue transplants, 9 fresh and 3 frozen. In two patients, the reason for ovarian failure was cancer chemotherapy and radiation, and in eight patients the premature ovarian failure was idiopathic. RESULTS: There have been 14 pregnancies in these 10 women resulting in 11 healthy babies. Nine babies resulted from fresh ovary transplants, and two were from the 3 frozen transplants. All 11 children are normal and healthy. Two of the 11 healthy babies were in women who had received pelvic radiation as part of a bone marrow transplant. Duration of function of the grafts varied from only two years (where the donor ovary had a prior low antral follicle count) to over five years. All recipients of ovarian grafts, whether fresh or frozen, resumed menstrual cycling and ovulation within 4.5 months of transplantation and serum FSH returned to normal levels at that time. There was no apparent difference in return of ovarian function between the nine fresh and the three frozen grafts. CONCLUSION: Ovary transplantation with cortical grafts, whether fresh or frozen, appears to give robust results with most patients having healthy babies and all having resumption of ovulation. The long duration of function of most of the fresh grafts suggest there may be less damage from ischemia time than might have been previously thought.