Transplantation of refreezed ovarian tissue after unexpected occurrence of endometriosis

Background Ovarian insufficiency is a concern for long-term cancer survivors. Ovarian-cryopreservation is a fertility preservation-technique through transplantation of frozen-thawed tissue; actual organ function and hormonal production is preserved. Perimenopausal endometriosis is rare, however it can be surprising diagnosed in transplantation of cryopreserved tissue. The thawed tissue may not be transplanted and has to be refrozen.

Methods 19-year-old woman with Hodgkin lymphoma underwent ovarian-cryopreservation before chemotherapy. She had an irregular menses with perimenopausal hormonal laboratory after chemotherapy, but no endometriosis symptoms. Fourteen years later she request tissue transplantation due to the desire to have children and underwent laparoscopy with the intention of transplanting the thawed tissue. However, endometriosis was diagnosed, surgery was canceled and the tissue was refrozen. After removing the lesions the twice-cryopreserved tissue was thawed and transplanted four months later.

Results Ovarian function returned two months after transplantation. Ten months later mild FSH-stimulation was initiated. When ultrasonography revealed a 17 mm follicle in the graft, one oocyte was obtained by follicular-puncture, fertilized by IVF and transferred. On day 14 after transfer, a positive hCG-Level was detected. After an uncomplicated pregnancy a healthy child was delivered.

Conclusions 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. Against the background of increasing numbers of candidates for transplantation of ovarian tissue is expected that the combination chemotherapy followed by endometriosis will increase.

Publication History

Article published online:
11 October 2022