title: Full-term newborn after repeated ovarian tissue transplants in a patient treated for Ewing sarcoma by sterilizing pelvic irradiation and chemotherapy.
abstract: We report the first successful transplantation of cryopreserved ovarian cortical tissue into heavily irradiated tissues in a patient who had received sterilizing pelvic radiotherapy (54 Gy) and 40 weeks of intensive high-dose chemotherapy for the treatment of Ewing's sarcoma 14 years earlier. Repeated transplantation procedures were required to obtain fully functional follicular development. Enlargement of the transplants over time and increase of the size of the uterus were demonstrated on sequential ultrasonographic examinations. Eggs of good quality that could be fertilized in vitro were obtained only after a substantial incremental increase of the amount of ovarian tissue transplanted. Single embryo replacement resulted in a normal pregnancy and the birth of a healthy child by cesarean section at full-term. No neonatal or maternal postoperative complications occurred. Women facing high-dose pelvic radiotherapy should not be systematically excluded from fertility preservation options, as is currently the trend.
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Kenny A
authors.initials: KA
authors.lastname: Rodriguez-Wallberg
authors.forename: Per-Olof
authors.initials: PO
authors.lastname: Karlström
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Rezapour
authors.forename: Enrique
authors.initials: E
authors.lastname: Castellanos
authors.forename: Julius
authors.initials: J
authors.lastname: Hreinsson
authors.forename: Carsten
authors.initials: C
authors.lastname: Rasmussen
authors.forename: Mona
authors.initials: M
authors.lastname: Sheikhi
authors.forename: Bettina
authors.initials: B
authors.lastname: Ouvrier
authors.forename: Béla
authors.initials: B
authors.lastname: Bozóky
authors.forename: Jan I
authors.initials: JI
authors.lastname: Olofsson
authors.forename: Monalill
authors.initials: M
authors.lastname: Lundqvist
authors.forename: Outi
authors.initials: O
authors.lastname: Hovatta
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D015925:Cryopreservation / Q000379:methods; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D050498:Live Birth; D010053:Ovary / Q000637:transplantation*; D010060:Ovulation / Q000187:drug effects / Q000528:radiation effects; D010388:Pelvis / Q000528:radiation effects; D011247:Pregnancy; D012512:Sarcoma, Ewing / Q000628:therapy*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Cancer; chemotherapy; fertility preservation; iatrogenic ovarian failure; live birth; ovarian tissue cryopreservation; ovarian transplantation; pregnancy; survivorship; uterine irradiation