title: Four spontaneous pregnancies and three live births following subcutaneous transplantation of frozen banked ovarian tissue: what is the explanation?
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Institute for Fertility Preservation, New York Medical College-Westchester Medical Center, Valhalla, New York 10595, USA. koktay@fertilitypreservation.org
authors.forename: Kutluk
authors.initials: K
authors.lastname: Oktay
authors.forename: Ilgın
authors.initials: I
authors.lastname: Türkçüoğlu
authors.forename: Kenny A
authors.initials: KA
authors.lastname: Rodriguez-Wallberg
mesh_terms: 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