Abstract


OBJECTIVE: To determine the best method of freezing, and report overall duration of function and live baby rate, after ovary tissue freeze and transplant for young cancer patients.
DESIGN: 13 patients over an eight year period underwent thaw and transplantation of ovarian tissue that had been frozen up to 19 years earlier, with detailed follow-up of hormones, menstruation, pregnancies, and birth. Seven had undergone slow freeze, and 6 had undergone vitrification. view more

OBJECTIVE: To determine the best method of freezing, and report overall duration of function and live baby rate, after ovary tissue freeze and transplant for young cancer patients.
DESIGN: 13 patients over an eight year period underwent thaw and transplantation of ovarian tissue that had been frozen up to 19 years earlier, with detailed follow-up of hormones, menstruation, pregnancies, and birth. Seven had undergone slow freeze, and 6 had undergone vitrification.
MATERIALS AND METHODS: All cancer patients varying from age 18 to age 31 who returned with POF to have their frozen ovary tissue transplanted back from 10 years ago to 2 years ago (over an 8 year period) are included in this retrospective cohort study. Their ovary tissue was frozen from 19 years ago to 5 years ago. Slow freeze was used until 10 years ago, after which only vitrification was employed exclusively. We now have long term follow-up of these 13 cases, with monthly evaluation of hormones, cycling, pregnancy, and live birth rate, and we can compare the results of slow freeze cases with those who had undergone vitrification. A total of 90 patients have undergone ovary tissue freeze, but only 13 have returned for the transplant.
RESULTS: All patients had return of ovarian function from 4 to 5 months post-op. In all cases the return of function was accompanied by a very sharp rise in AMH for 4 months, with a subsequent decline to low levels. 8 of the 13 are still functioning. Duration of function varied from 561 days to 1,641 days (this graft is still functioning). Five of the 13 are still functioning for over 3 ½ years. There are 9 healthy babies (69%) from 10 pregnancies (76%). Slow freeze resulted in 5 healthy babies out of 7 transplants. Vitrification resulted in 4 healthy babies out of 6 transplants. However slow freeze cases had a shorter duration of function (614 to 1155 days) and 5 of the 7 are no longer functioning, whereas vitrification cases are all still functioning over 3 ½ years (1281 days to 1641 days).
CONCLUSIONS: Ovary tissue freezing is a robust method for preserving fertility in young cancer patients. Slow freeze yields pregnancy results equivalent to vitrification. However vitrified transplants have a longer duration of function, verifying our in vitro report earlier of higher oocyte survival with vitrification compared to slow freeze.

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