Monitoring the ovaries after autotransplantation of cryopreserved ovarian tissue: endocrine studies, in vitro fertilization cycles, and live birth

Objective: To investigate fertility potential of ovarian tissue harvested after chemotherapy, to monitor ovarian recovery after transplantation, and to compare with in vitro fertilization (IVF) cycles. Design: Clinical and endocrine study. Setting: IVF unit and hematology department in a tertiary university hospital. Patient(s): A 28-year-old patient suffering from non-Hodgkin's lymphoma had some of her ovarian tissue cryopreserved shortly after conventional chemotherapy and failure to respond to ovarian stimulation but before sterilizing treatment. Intervention(s): Transplantation of cryopreserved ovarian tissue; four IVF cycles. Main Outcome Measure(s): Gonadotropins, ovarian steroids, anti-Mullerian hormone (AMH), inhibin B, ovarian histology, sonography, and outcome of IVF cycles. Result(s): Large number of primordial follicles were present in the harvested tissue. During the first months after transplantation, gonadotropins were high, AMH and inhibin B were low, and in three IVF cycles, eggs were not found. After recovery of endocrine activity 9 months after transplantation, a mature oocyte was retrieved. Embryo transfer resulted in a normal pregnancy and delivery of a healthy baby. Although spontaneous menstruation resumed after delivery, endocrine profile 22 months after transplantation indicated low reserve. Conclusion(s): The recovery of endocrine function after transplantation correlated with the result of oocyte recovery. Fertility preservation using ovarian tissue is effective also in cases when the ovaries are injured after chemotherapy. However, transplant life span is limited.