Center for Assisted Reproduction, Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara,, 06620, Turkey.
Department of Histology and Embryology, Ankara University Faculty of Medicine, Ankara,, 06230, Turkey.
J Assist Reprod Genet. 2020 Aug;37(8):2033-2043. doi: 10.1007/s10815-020-01850-2. Epub 2020 Jun 16.
To report the first live birth after frozen-thawed ovarian transplantation in Turkey and the second case for an acute lymphoblastic leukemia (ALL) survivor in the world.
A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels > 100 IU/ml and estradiol < 20 pg/ml and hematologically in molecular remission. Detailed molecular analysis, standard histology, and immunohistochemistry demonstrated that the thawed tissue is free of malignant cells.
Six months following OTT, she had spontaneous menstruation with serum FSH 11 IU/ml and estradiol 53 pg/ml. Two consecutive IVF cycles yielded three top-quality embryos. Following three embryo transfer cycles, one fresh and two frozen, a healthy term live birth was achieved. Frozen-thawed-transplanted tissues were extracted during caesarean delivery upon the patient's request after a total period of 25 months in vivo, and histopathological evaluation revealed that the tissue was free of leukemic infiltration.
The authors report the first pregnancy and live birth in Turkey and the second live birth in the world following transplantation of frozen-thawed ovarian tissue in a leukemia survivor. As the transplanted tissues were removed during caesarean delivery, histological findings prove the functionality and the malignant-free status of the transplanted tissue during the grafted period.
报告土耳其首例冷冻卵巢组织移植后的活产和世界上第二例急性淋巴细胞白血病（ALL）幸存者的活产。
一名 19 岁患者于 2010 年在脐带血移植前行卵巢组织冷冻保存（OTC）。她被诊断为 ALL，骨髓活检显示 90%的原始淋巴细胞 ALL-L2 型，核型分析显示 t（9；22）（q34；q11）的相互易位。患者接受柏林-法兰克福-慕尼黑（BFM）方案治疗，在生育力保存前达到完全缓解。血清 AMH 水平为 1.5ng/ml，超声检查显示 12 个窦卵泡。她了解了生育力保存方案，并决定在 2011 年 4 月脐带血移植前进行 OTC，获得其书面同意。当患者处于绝经状态，血清 FSH 水平>100IU/ml且雌二醇<20pg/ml且血液学上处于分子缓解时，于 2017 年进行卵巢组织移植（OTT）。详细的分子分析、标准组织学和免疫组织化学显示，解冻组织无恶性细胞。
OTT 后 6 个月，她出现自发性月经，血清 FSH 为 11IU/ml，雌二醇为 53pg/ml。连续进行了两次 IVF 周期，获得了三个优质胚胎。经过三次胚胎移植周期（一次新鲜周期和两次冷冻周期），成功获得了一个健康足月的活产儿。应患者要求，在体内存活 25 个月后，在剖宫产期间取出冷冻-解冻-移植的组织，组织病理学评估显示组织无白血病浸润。
作者报告了土耳其首例妊娠和活产，以及世界上第二例冷冻卵巢组织移植后白血病幸存者的活产。由于在剖宫产期间取出了移植组织，组织学结果证明了移植组织在移植物期间的功能和无恶性状态。
