Successful autotransplantation of cryopreserved ovarian tissue with recovery of the ovarian function

Abstract

Objectives: The aim of the study was autotransplantation of cryopreserved ovarian tissue to a patient suffering from premature ovarian failure caused by aggressive oncological therapy.

Material and methods: A 28-year-old woman, GII PI, was diagnosed with invasive adenocarcinoma of the cervix at 18 weeks of gestation. At 31 weeks of gestation, a cesarean section was performed, resulting in the delivery of a healthy male newborn, followed by simultaneous, radical hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy. Half of each ovary was cryopreserved. The patient was scheduled for radiochemotherapy, supplemented with brachytherapy. After the intervention, the patient experienced menopausal symptoms. The basal hormonal levels were: estradiol – 2 pg/ml, FSH – 96.52 IU/ml, LH – 37.55 IU/ml, AMH – 0.03 ng/ml. Thirteen months after surgery, the peritoneal pocket was formed on the anterior abdominal wall during laparoscopy and heterotrophic autotransplantation of the frozen-thawed ovarian tissue was performed, replacing 59% of the tissue.

Results: Nine weeks after transplantation, symptom resolution, an increase in estradiol (53 pg/ml), and a decrease in FSH (64.89 IU/ml) and LH (33.39 IU/ml) levels were noted. Twenty-four weeks after transplantation, high estradiol levels (269 pg/ml), normal level of FSH (5.92 IU/ml) and LH (4.09 IU/ml), and an increase in AMH (0.37 ng/ml) were observed. Follicular development in the transplanted ovarian tissue was confirmed.

Conclusions: Cryopreservation and transplantation of ovarian tissue allowed to restore the ovarian function. It could offer an alternative physiological solution to treating premature ovarian failure caused by oncological therapy.