To improve outcome after ovarian tissue cryopreservation and transplantation: Clinical approach based on a case series and literature review.

AIM: Ovarian tissue cryopreservation (OTC) is an acceptable fertility preservation technique in prepubertal girls and those unable to undergo ovarian stimulation for oocyte vitrification. Currently, there is limited data regarding the optimal fertility approach within this patient population. We aimed to determine a protocol for clinicians to help patients that underwent postpubertal OTC and return with the wish to conceive.

METHODS

In this study, we describe the management and outcome of 14 patients that underwent OTC and ovarian tissue transplantation (OTT) in our tertiary center and review the existing literature on management and outcome after OTC and OTT.

RESULTS

Our findings suggest pregnancy chances after OTT are highest in patients <36 years of age, with normal ovarian reserve at the time of OTC, who have not received radiotherapy to the pelvic area. Chances of pregnancy after heterotopic transplantation are low. Assisted reproductive technology (ART) outcomes after OTT are lower than in the general population with subfertility.

CONCLUSIONS

A passive ART approach is advised after OTT, except in patients with pre-existing fertility issues. For others, ART can be considered if pregnancy is not achieved within 10 months after ovarian function recovery. Repeated transplantation has limited efficacy and should be carefully considered, especially in those who did not regain ovarian function after first OTT.