Four spontaneous pregnancies and three live births following subcutaneous transplantation of frozen banked ovarian tissue: what is the explanation?
OBJECTIVE
To report the long-term follow-up of an experimental heterotopic ovarian transplantation with frozen-thawed ovarian tissue.


METHODS
Long-term follow-up of an experimental surgery; case report.


METHODS
Academic reproductive medicine center.


METHODS
A 28-year-old cancer survivor with previous Hodgkin disease and relapse.


METHODS
Laparoscopic oophorectomy for ovarian cryopreservation before preconditioning chemotherapy for hematologic stem cell transplantation. Ovarian tissue thawing and subcutaneous heterotopic ovarian transplantation in the lower abdominal wall 2½ years after the hematologic stem cell transplantation.


METHODS
Resumption of ovarian function after transplantation, recovery of fertility, and pregnancy outcome.


RESULTS
Follicle development was observed in the graft 2 months after transplantation, and a P value of 14 ng/mL indicated ovulation. The patient conceived spontaneously four times within 5 years and delivered three children. The in situ ovary remained atrophic but showed occasional follicle activity contemporaneously with the graft.


CONCLUSIONS
The mechanism behind spontaneous restoration of fertility with consecutive viable pregnancies after a heterotopic ovarian transplantation needs to be explored. Further laboratory and clinical research will be needed to explore the true origin of pregnancies after ovarian transplantations.
Oktay
Kutluk
K
Department of Obstetrics and Gynecology, Institute for Fertility Preservation, New York Medical College-Westchester Medical Center, Valhalla, New York 10595, USA. koktay@fertilitypreservation.org
Türkçüoğlu
Ilgın
I
Rodriguez-Wallberg
Kenny A
KA
D000328:Adult; D005260:Female; D005615:Freezing; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D009369:Neoplasms / Q000534:rehabilitation; D010053:Ovary / Q000502:physiology / Q000637:transplantation*; D011247:Pregnancy; D011256:Pregnancy Outcome; D020127:Recovery of Function / Q000502:physiology; D040521:Subcutaneous Tissue; D014015:Tissue Banks; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic