Ovarian cryopreservation and transplantation for fertility preservation for medical indications: report of an ongoing experience

OBJECTIVE: To assess the indications, safety, utilization, and success of ovarian tissue freezing and transplantation. DESIGN: Prospective longitudinal analysis. SETTING: Academic medical centers. PATIENT(S): Fifty-nine women who underwent ovarian tissue cryopreservation with a slow freezing technique between May 1997 and March 2008. A follow-up was conducted 36.8 +/- 3.6 months after the procedure. INTERVENTION(S): Ovarian tissue harvesting and cryopreservation. MAIN OUTCOME MEASURE(S): Indications, safety, and utilization rates. RESULT(S): The mean age (+/- SE) was 26.7 +/-1.2 years (range 4-44 years). The majority of patients had either hematologic malignancies (45.7%) or breast cancer (22%). Of these, 57.6% underwent hematopoietic stem cell transplantation. No complications occurred and no histologic evidence of cancer was found in the harvested tissue. The median length of storage was 3.5 +/- 0.3 years (0.06-10.5 years). Fifty-six of 59 patients have not yet used their ovarian tissue. The reasons for nonutilization were social/personal, being still under treatment, and death in 54%, 38%, and 8%, respectively. Only three women (5.1%) underwent transplantation, two with the heterotopic (abdominal wall) and one with the orthotopic technique. One woman with a heterotopic transplant conceived spontaneously and delivered. Of the three transplants, one ceased function after 9 months and two are still functioning at up to 7 years follow-up. CONCLUSION(S): Ovarian tissue harvesting appears to be safe but the experience with ovarian transplantation is still limited due to low utilization. As a result, the true value of this procedure remains to be determined.