Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
Faculty of Medicine, University of Freiburg, Freiburg, Germany.
J Ovarian Res. 2022 May 5;15(1):53. doi: 10.1186/s13048-022-00972-8.
Ovarian insufficiency is a major concern for long-term cancer survivors. Ovarian tissue cryopreservation for fertility preservation is an emerging technique that has proven successful over the past decade through transplantation of frozen-thawed ovarian tissue. Compared to other established techniques, such as oocyte freezing, ovarian tissue cryopreservation preserves actual organ function and thus the production of sex hormones. Endometriosis in perimenopausal women is rare, however it can be surprising diagnosis in the planned transplantation of cryopreserved ovarian tissue and the already thawed tissue may not be transplanted, so that it has to be refrozen.
Ovarian function returned in the patient two months after transplantation, as shown by estrogen production. Ten months after the ovarian tissue transplantation mild stimulation with FSH was initiated in accordance with a low-dose protocol. When ultrasonography revealed a follicle 17 mm in size in the ovarian graft, hCG was added and after follicular puncture one oocyte was obtained. The oocyte could be fertilized by IVF and transferred to the uterus. On day 14 after embryo-transfer, a positive hCG-Level was detected and after an uncomplicated pregnancy a healthy child was delivered.
We report the first pregnancy and live birth achieved using transplantation of thawed and refrozen ovarian tissue in a woman treated by chemotherapy and subsequent endometriosis surgery. Refreezing of cryopreserved ovarian tissue is not a hindrance to successful transplantation of ovarian tissue. Against the background of increasing numbers of candidates for transplantation of ovarian tissue is expected that the combination chemotherapy followed by endometriosis will increase.
卵巢功能不全是长期癌症幸存者的主要关注点。卵巢组织冷冻保存用于生育力保存是一种新兴技术，通过冷冻-解冻卵巢组织移植，在过去十年中已被证明是成功的。与其他已建立的技术（如卵母细胞冷冻保存）相比，卵巢组织冷冻保存保留了实际的器官功能，从而保持了性激素的产生。围绝经期妇女的子宫内膜异位症很少见，但在计划移植冷冻保存的卵巢组织时可能会出现令人惊讶的诊断，而且已经解冻的组织可能不会被移植，因此必须重新冷冻。
患者在移植后两个月卵巢功能恢复，表现为雌激素的产生。在卵巢组织移植十个月后，根据低剂量方案开始用 FSH 进行轻度刺激。当超声检查显示卵巢移植物中有一个 17 毫米大小的卵泡时，添加了 hCG，并且在卵泡穿刺后获得了一个卵母细胞。卵母细胞可以通过 IVF 受精并转移到子宫。胚胎移植后第 14 天，检测到 hCG 水平呈阳性，随后进行了一次简单的妊娠，成功分娩了一个健康的孩子。
我们报告了首例通过解冻和重新冷冻卵巢组织移植实现的妊娠和活产，该患者接受了化疗和随后的子宫内膜异位症手术治疗。冷冻保存卵巢组织的重新冷冻不会阻碍卵巢组织的成功移植。随着越来越多的候选人需要进行卵巢组织移植，预计接受化疗后合并子宫内膜异位症的患者数量将会增加。
