Follow-up of ovarian function post-chemotherapy following ovarian cryopreservation and transplantation.
BACKGROUND
The purpose of this study was to assess the ovarian function after treatment of a malignant disease in women who previously had cortical tissue from an entire ovary cryopreserved prior to chemotherapy, and to assess ovarian function after autotransplantation of cryopreserved ovarian tissue. All were treated with chemotherapeutic drugs with an estimated high risk of inducing ovarian failure.


METHODS
Twenty-two women with breast cancer (n = 8), Hodgkin's disease (n = 6), non-Hodgkin's (n = 2), leukaemia (n = 5) or brain tumour (n = 1) underwent a clinical examination >18 months after cryopreservation. Three patients with premature ovarian failure had ovarian tissue autotransplanted orthotopically and heterotopically. Ovarian function was assessed by ultrasonography of the remaining ovary and hormone measurements.


RESULTS
Nine of 22 women (41%) had sonographic and hormonal signs of ovarian failure with ovarian volumes <1.3 cm3, no antral follicles and high FSH levels (median 57.1 IU/l). Thirteen of the 22 women (59%) still menstruated and 10 had a seemingly normal ovarian function, with a median ovarian volume of 6.8 cm3, a median number of antral follicles of six, FSH <15 IU/l and normal estradiol levels. All three patients with autotransplanted ovarian tissue regained ovarian function as confirmed by return of menses, follicles on ultrasonography and normalized hormone levels. Two embryos were created from the crypreserved tissue after IVF.


CONCLUSIONS
Treatment with bone-marrow transplantation and/or high doses of alkylating agents led to ovarian failure in all patients. Autotransplantation of ovarian tissue led to return of ovarian function.
Schmidt
K L T
KL
The Fertility Clinic, section 4071, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark. tryde@dadlnet.dk
Andersen
C Yding
CY
Loft
A
A
Byskov
A G
AG
Ernst
E
E
Andersen
A Nyboe
AN
D000293:Adolescent; D000328:Adult; D000477:Alkylating Agents / Q000494:pharmacology; D016026:Bone Marrow Transplantation; D001932:Brain Neoplasms / Q000188:drug therapy; D001943:Breast Neoplasms / Q000188:drug therapy; D015925:Cryopreservation; D005260:Female; D005298:Fertility; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy; D006801:Humans; D007938:Leukemia / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008598:Menstruation; D009865:Oocytes / Q000378:metabolism; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D010053:Ovary / Q000187:drug effects* / Q000502:physiology* / Q000637:transplantation*; D016649:Primary Ovarian Insufficiency; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography
D000477:Alkylating Agents; D005640:Follicle Stimulating Hormone