Fertility Preservation Center, Division of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium.
Fertil Steril. 2020 Aug;114(2):388-397. doi: 10.1016/j.fertnstert.2020.03.037. Epub 2020 Jun 27.
To report ovarian tissue autotransplantation (AT) results and describe the relationship between technical and clinical factors and outcomes.
Multicenter retrospective cohort study.
Tertiary medical centers.
PATIENT(S): Infertile patients who had stored ovarian tissue before sterilizing treatment and returned for AT with the aim of conceiving.
INTERVENTIONS(S): Ovarian tissue cryopreservation (OTC) and AT, endocrine monitoring, in vitro fertilization.
MAIN OUTCOME MEASURE(S): Endocrine performance, pregnancy and live-birth rates.
RESULT(S): From 2004 to 2018, 70 patients underwent 87 ATs. Sixty patients undergoing 70 ATs met the inclusion criteria. After AT, menses returned in 94% of patients and median FSH dropped from 68 to 19 IU/mL. Fifty pregnancies and 44 deliveries were attained, with 50% of women achieving at least one pregnancy and 41.6% at least one delivery. Twelve patients underwent AT more than once and had their endocrine activity restored in case menses recurred after the first transplantation. Repeated transplantations yielded five live births in three patients, two of whom had already given birth after the first transplantation. Preharvesting chemotherapy was not associated with inferior outcomes. Of seven patients whose pelvis was exposed to radiation before AT, four conceived and delivered. Neither tissue dimensions nor surgical approach affected fertility outcomes.
CONCLUSION(S): OTC is highly effective at restoring fertility in sterilized patients, and prior exposure to chemotherapy should not be considered a contraindication. Repeated AT should be contemplated in case of graft malfunction, especially if previous transplantation was successful. In selected cases, conception and delivery may be feasible after pelvic exposure to radiation.
报告卵巢组织自体移植（AT）的结果，并描述技术和临床因素与结局之间的关系。
多中心回顾性队列研究。
三级医疗中心。
接受过绝育治疗前储存卵巢组织并返回进行 AT 以实现妊娠的不孕患者。
卵巢组织冷冻保存（OTC）和 AT、内分泌监测、体外受精。
内分泌功能、妊娠和活产率。
2004 年至 2018 年，70 例患者进行了 87 次 AT。60 例接受 70 次 AT 的患者符合纳入标准。AT 后，94%的患者恢复月经，中位数 FSH 从 68IU/mL 降至 19IU/mL。获得 50 例妊娠和 44 例分娩，50%的女性至少获得一次妊娠，41.6%至少获得一次分娩。12 例患者进行了不止一次 AT，如果第一次移植后月经再次出现，他们的内分泌活动得到恢复。在 3 名患者中，重复移植产生了 5 例活产，其中 2 名患者在第一次移植后已经分娩。预处理化疗与较差的结局无关。在 7 例接受 AT 前骨盆暴露于辐射的患者中，有 4 例受孕并分娩。组织尺寸和手术方法均不影响生育结局。
OTC 非常有效地恢复了绝育患者的生育能力，并且之前接受过化疗不应被视为禁忌症。如果移植物功能障碍，应考虑重复 AT，特别是如果之前的移植成功。在选择的病例中，骨盆暴露于辐射后仍有可能受孕和分娩。
