Unexpected diagnose of endometriosis in women undergoing ovarian tissue transplantation

Laura Lotz, AK Dietl, Inge Hoffmann, A. Müller, Stefanie Burghaus, MW Beckmann, Ralf Dittrich
In: Geburtshilfe und Frauenheilkunde · 2022 · vol. 82(10) , pp. e119 · doi:10.1055/s-0042-1756935 · W4307891331
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This study investigated women with premature menopause and endometriosis diagnosed during ovarian tissue transplantation to explore potential explanations, effects on pregnancy rates, and associations with original cancer.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This paper investigated 17 women who underwent ovarian tissue transplantation for fertility restoration and were diagnosed with endometriosis unexpectedly during the transplantation procedure. The authors removed lesions and evaluated preexisting conditions, prior hormonal exposures and cytotoxic treatment history, endometriosis staging, pain-related symptoms, and pregnancy and live birth outcomes. They found that most cases were rASRM stage I, with few reporting dysmenorrhea and no pelvic pain or dyspareunia, and reported a pregnancy rate of 41.2% and a live birth rate of 35.3%. The study is limited by its small cohort and observational design, without a comparison group. This paper is centrally about endometriosis — it specifically describes endometriosis diagnosed during ovarian tissue transplantation in women with premature menopause and analyzes associated pregnancy outcomes.

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Abstract

Introduction Ovarian-cryopreservation with subsequent transplantation is a restoring fertility option in women at risk of premature ovarian-failure. The association between infertility and endometriosis is well known. Although endometriosis usually ends with the menopause due to decreasing estrogen, endometriosis can occur after menopause. This study aims to investigate women with premature menopause with endometriosis diagnosed during ovarian-tissue-transplantation, and to address the questions of how endometriosis after cytotoxic treatment and premature menopause might be explained, whether it affects pregnancy rates, and whether there is an association between endometriosis and the original cancer.
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Introduction

Ovarian-cryopreservation with subsequent transplantation is a restoring fertility option in women at risk of premature ovarian-failure. The association between infertility and endometriosis is well known. Although endometriosis usually ends with the menopause due to decreasing estrogen, endometriosis can occur after menopause. This study aims to investigate women with premature menopause with endometriosis diagnosed during ovarian-tissue-transplantation, and to address the questions of how endometriosis after cytotoxic treatment and premature menopause might be explained, whether it affects pregnancy rates, and whether there is an association between endometriosis and the original cancer.

Methods

Seventeen patients underwent ovarian-tissue-transplantation for fertility-restoration and were diagnosed with endometriosis during transplantation. The lesions were removed and ovarian tissue was transplanted. Preexisting conditions, hormonal therapy, endometriosis stage pain assessment, pregnancy and live birth rate were evaluated.

Results

The mean age was 29.5 ± 6.3 years (time of ovarian-tissue-harvest) and 34.6 ± 4.3 years (time of transplantation). Prior to transplantation, four took hormone replacement therapy, four oral contraceptives and two tamoxifen. Twelve had rASRM stage I endometriosis and five stage II. Four reported dysmenorrhea, none complained about pelvicpain or dyspareunia. The pregnancy-rate was 41.2% and live-birth-rate 35.3%. The conception of three pregnancies was spontaneously and four after natural cycle IVF/ICSI.

Conclusions

This study highlights the under-researched association between endometriosis in women entering premature menopause either after gonadotoxic treatment or due to primary ovarian-insufficiency. As more and more patients seek to have their cryopreserved ovarian tissue transplanted to fulfill their desire to have children, specialists will inevitably encounter women with this condition. Publication History Article published online: 11 October 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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