Unexpected diagnose of endometriosis in women undergoing ovarian tissue transplantation

Introduction Ovarian-cryopreservation with subsequent transplantation is a restoring fertility option in women at risk of premature ovarian-failure. The association between infertility and endometriosis is well known. Although endometriosis usually ends with the menopause due to decreasing estrogen, endometriosis can occur after menopause. This study aims to investigate women with premature menopause with endometriosis diagnosed during ovarian-tissue-transplantation, and to address the questions of how endometriosis after cytotoxic treatment and premature menopause might be explained, whether it affects pregnancy rates, and whether there is an association between endometriosis and the original cancer.

Methods Seventeen patients underwent ovarian-tissue-transplantation for fertility-restoration and were diagnosed with endometriosis during transplantation. The lesions were removed and ovarian tissue was transplanted. Preexisting conditions, hormonal therapy, endometriosis stage pain assessment, pregnancy and live birth rate were evaluated.

Results The mean age was 29.5 ± 6.3 years (time of ovarian-tissue-harvest) and 34.6 ± 4.3 years (time of transplantation). Prior to transplantation, four took hormone replacement therapy, four oral contraceptives and two tamoxifen. Twelve had rASRM stage I endometriosis and five stage II. Four reported dysmenorrhea, none complained about pelvicpain or dyspareunia. The pregnancy-rate was 41.2% and live-birth-rate 35.3%. The conception of three pregnancies was spontaneously and four after natural cycle IVF/ICSI.

Conclusions This study highlights the under-researched association between endometriosis in women entering premature menopause either after gonadotoxic treatment or due to primary ovarian-insufficiency. As more and more patients seek to have their cryopreserved ovarian tissue transplanted to fulfill their desire to have children, specialists will inevitably encounter women with this condition.

Publication History

Article published online:
11 October 2022