Ovarian cryopreservation and transplantation for fertility preservation for medical indications: report of an ongoing experience
Received 17 April 2008; received in revised form 28 September 2008; accepted 3 October 2008. published online 14 November 2008.
Objective
To assess the indications, safety, utilization, and success of ovarian tissue freezing and transplantation.
Design
Prospective longitudinal analysis.
Setting
Academic medical centers.
Patient(s)
Fifty-nine women who underwent ovarian tissue cryopreservation with a slow freezing technique between May 1997 and March 2008. A follow-up was conducted 36.8 ± 3.6 months after the procedure.
Intervention(s)
Ovarian tissue harvesting and cryopreservation.
Main Outcome Measure(s)
Indications, safety, and utilization rates.
Result(s)
The mean age (± SE) was 26.7 ±1.2 years (range 4–44 years). The majority of patients had either hematologic malignancies (45.7%) or breast cancer (22%). Of these, 57.6% underwent hematopoietic stem cell transplantation. No complications occurred and no histologic evidence of cancer was found in the harvested tissue. The median length of storage was 3.5 ± 0.3 years (0.06–10.5 years). Fifty-six of 59 patients have not yet used their ovarian tissue. The reasons for nonutilization were social/personal, being still under treatment, and death in 54%, 38%, and 8%, respectively. Only three women (5.1%) underwent transplantation, two with the heterotopic (abdominal wall) and one with the orthotopic technique. One woman with a heterotopic transplant conceived spontaneously and delivered. Of the three transplants, one ceased function after 9 months and two are still functioning at up to 7 years follow-up.
Conclusion(s)
Ovarian tissue harvesting appears to be safe but the experience with ovarian transplantation is still limited due to low utilization. As a result, the true value of this procedure remains to be determined.
Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York and Institute for Fertility Preservation, Center for Human Reproduction, New York, New York
Reprint requests: Kutluk Oktay, M.D., F.A.C.O.G., Institute for Fertility Preservation, 21 East 69 Street, New York, NY 10021 (FAX: 212-994-4499).
K.O. has nothing to disclose. O.O. has nothing to disclose.
ABSTRACT