Ovary Transplantation for Fertility Preservation in Cancer Patients: Fresh and Frozen

A series of monozygotic (MZ) twin pairs discordant for premature ovarian failure presented an unusual opportunity to study fresh ovarian transplantation. This unusual series then helped us to refine the techniques for both fresh and frozen ovary transplantation in order to preserve fertility for cancer patients who would otherwise suffer iatrogenic iatrogenic ovarian failure from their chemotherapy and radiation. Ten MZ twin pairs requested ovarian transplantation and nine of them have undergone fresh transplantation along with cryopreservation of spare donor ovarian tissue. Eight of them had a fresh cortical tissue transplant, and two of those eight received a second frozen–thawed transplant after the first transplant ceased functioning years later. One of the 9 MZ twins had a fresh whole ovary microvascular transplant rather than a cortical graft. 62 cancer patients had had ovarian tissue cryopreserved from 1997 till the present, and one thus far has had her frozen ovarian tissue transplanted back after she was cured and married, which was 12 years after her ovary had been frozen and she had undergone menopause from her bone marrow transplant. All recipients reinitiated ovulatory menstrual cycles and normal Day 3 serum FSH levels by 77–142 days. Seven of the nine fresh transplants have already conceived naturally (three of them twice), producing 9 healthy babies. One required IVF because she had congenital absence of ovaries and fallopian tubes, and delivered healthy IVF twins. Currently, eleven healthy babies (including two from frozen ovary transplants have been delivered out of 14 pregnancies in 10 patients, two of 322 Clinical Infertility whom were the cancer cases. There is only one patient out of the ten that has not had a healthy pregnancy, but she was 40 years old when she first underwent the transplant. One successful fresh transplant ceased functioning by four years, but then this patient conceived again after a frozen–thawed secondary transplant. Another ceased functioning after two years, but again conceived after a frozen–thawed secondary transplant. There was no apparent difference in return of ovarian function between the nine fresh ovarian grafts and the three frozen grafts. Ovarian transplantation appears to restore ovulatory function robustly. Fourteen pregnancies, leading to 11 healthy babies, including two after cryopreservation, bode well for application of ovarian tissue freezing and transplantation to fertility preservation. A comparison of slow freeze technology to vitrification of ovarian tissue strongly favors