Transplantation of small ovarian tissue fragments using pipelle device is effective: method evaluation and reproductive outcomes

Purpose: To assess the feasibility, effectiveness, and reproductive outcomes of transplantation of tiny cryopreserved ovarian pieces through a pipelle cannula during laparoscopic surgery. Methods: A retrospective study of patients who underwent ovarian tissue transplantation for fertility restoration between 2004 and 2022. The “pipelle group” had their ovarian cortex cut into tiny pieces of ~ 1–2 mm³ before cryopreservation. The pieces were too small to be handled and transplanted via standard laparoscopic tools. Transplantation was performed using a pipelle cannula during laparoscopic surgery. The “control group” underwent transplants of ovarian cortex pieces 1–2 mm thick, measuring approximately 25–50 mm² pieces, using standard procedures. Results: The pipelle group consisted of 4 patients aged 19, 21, 27, and 28 years old at ovarian tissue cryopreservation (OTC). The control group consisted of 14 patients aged 21–30 years old. All pipelle patients restored their endocrine activity, and all of them conceived. FSH levels dropped during the first 3 months following the pipelle transplant. IVF cycle outcomes were similar for both groups. All patients from the pipelle group conceived, resulting in 5 pregnancies and 4 live births (one patient had 2 deliveries, and one additional pregnancy is ongoing), compared to the control group, where 8 patients achieved a total of 20 pregnancies and 18 live births. Conclusion: Pipelle transplantation for tiny cryopreserved ovarian pieces is feasible and effective. This study opens a door for patients who had their ovaries cut into small pieces and may even simplify the procedure in some instances, making ovarian transplant more accessible. Trial registration: (#6531–19-SMC) [18/09/2019].