Second Clinical Pregnancy Following Repeat Ovarian Tissue Transplantation in an Acute Leukemia Survivor: First Report and Literature Overview.

Ovarian tissue cryopreservation (OTC) followed by autologous transplantation is an established fertility preservation strategy, particularly for women undergoing gonadotoxic cancer treatments. However, its safety in leukemia patients remains controversial due to the risk of malignant cell contamination. We report the case of a 33-year-old woman with a history of Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL) who achieved a second clinical pregnancy following repeated ovarian tissue transplantation (OTT). She underwent OTC at the age of 20 prior to myeloablative therapy. Her first OTT at age 28 resulted in a live birth. Five years later, a second OTT was performed using the remaining tissue, resulting in hormonal recovery and oocyte retrieval. Preimplantation genetic testing revealed 2 euploid embryos, and a frozen single embryo transfer resulted in a clinical pregnancy, that unfortunately ended in miscarriage at 13 weeks. No leukemia recurrence was observed during the follow-up. This is the first reported case of a second clinical pregnancy following repeated OTT in a leukemia survivor, supporting the feasibility of fertility restoration through multiple transplantations. With rigorous histological, immunohistochemical, and molecular screening where appropriate, OTT can be considered a safe and effective fertility preservation option in acute leukemia survivors.