CASE REPORT Infertility First reported clinical pregnancy following heterotopic grafting of cryopreservedovariantissue inawoman after a bilateral oophorectomy

Ovarian tissue cryopreservation and transplantation is a formof fertility preservation offered to youngwomenathigh riskof losing ovarian function after cancer treatment.While therehavebeen successful births resulting fromorthotopic site grafts,we report the first caseof an ongoing pregnancy from a heterotopic graft in a patient who had previously undergone bilateral oopherectomy for a granulosa cell tumour. Frozen–thawed ovarian tissue was transplanted to the anterior abdominal wall. Subsequent ovarian stimulation and transabdominal ultrasound-guided oocyte retrieval from the grafts resulted in two oocytes. These were fertilized with ICSI and two embryos were transferred. Serial ultrasounds have confirmed an ongoing 26-week intrauterine twin pregnancy. Thus, this first demonstration of a pregnancy from a heterotopic graft site provides unequivocal evidence that cryopreservation preserves complete follicle development and that normal ovarian function can occur at a non-ovarian site. This provides optimism for further efforts to assist women who have had oophorectomy and pelvic surgery or radiotherapy, without an appropriate orthotopic site for grafting.