Second children born after autotransplantation of cryopreserved ovarian tissue in a young patient previously treated with chemotherapy for Askin's diseasethe successful of fertility preservation program

Abstract

Oncological treatment was associated with a reduced ovarian reserve, the chance of a successful pregnancy is currently around 1/3 for those with ovarian-tissue autotransplantationOvarian tissue cryopreservation is an effective option,gaining ground as a valid method for fertility preservation especially for pre-pubertal patients and patients who have a short time between diagnosis of a disease and gonadotoxic treatment.More than 62 children worldwide have now been born following this procedure. Case report and a retrospectively analyse, of patients whose underwent ovarian tissue cryopreservation at IFER, Argentina between 1999-2015.One of these women, had orthotopic transplantation, after chemotherapy premature ovarian failure (POF) has now conceived again following natural conception. She gave birth to a healthy girl on 7/2015 and is therefore the second woman in the world to have had two children, from separate pregnancies, born as a result of transplanting frozen/thawed ovarian-tissue. 68 patients referred from private oncological units underwent cryopreservation of ovarian tissue before gonadotoxic therapy for malignant disease. 7 patients (10,3%) died during follow-up due to recurrence of disease. 24 post-pubertal patients without the need for grafts of cryopreserved tissue. 4 patients had undergone ovarian tissue transplantation in order to restore their fertility after remission of the disease and one of these women became pregnant twice and has given birth two healthy babies. In 2005 a 28 year old patient was referred for fertility preservation before undergoing aggressive chemotherapy for Askin tumor. Several strips of ovarian cortical tissue were obtained by laparoscopy and cryopreserved . The patient underwent surgical treatment, and chemotherapy (CVEA), ovarian failure was established. In 2009 orthotopic transplantation of frozen-thawed ovarian tissue was carried out by laparoscopy in the right ovary,.Three months after transplantations she resumed regular menses. Four IVF cycles were performed with no pregnancy.9/2012 POF was established. In 2/2013 another laparoscopy was performed with replacement of ovarian tissue this time in the left ovary. In 5/2013 spontaneous menses began. An Intrauterine Insemination resulted in pregnancy. In 2/2014, and after an uneventful pregnancy, a healthy baby boy was born.The patient was breastfeeding her first baby and returned to our fertility clinic in 9/2014 a pregnancy test revealed that she had already conceived naturally,after an uneventful pregnancy a normal healthy girl was born in 7/2015. The present result supports cryopreservation of ovarian tissue as a valid method of fertility preservation to be used in women facing gonadotoxic treatment. However alternative procedures such as oocyte or embryo cryopreservation should be considered as first options especially for older patients.