Ovarian Tissue Cryopreservation and Rates of Primary Ovarian Insufficiency in Adolescent Patients Undergoing Bone Marrow Transplant

Ovarian tissue cryopreservation (OTC) is mainly used for fertility preservation in girls and women facing a gonadotoxic treatment. If the woman subsequently becomes menopausal, the ovarian tissue may be transplanted to regain ovarian function, including fertility. The method was developed more than two decades ago and today thousands of women worldwide have undergone OTC. Fewer than 500 patients have had tissue transplanted and close to 100% of those regain ovarian function. Several technical aspects of OTC are now becoming more established, including high quantitative follicle survival, defining the size of the tissue resulting in optimal tissue revascularisation and follicle loss resulting from transport of ovarian tissue prior to freezing. We have used OTC to safeguard fertility in patients with genetic diseases, which for some diagnoses is purely experimental, as no transplantations is yet been performed. Usage of OTC beyond fertility is now also being considered; here, the endocrine function of follicles is the focus. It has been suggested that ovarian tissue stored in the reproductive years may be used to avoid premature ovarian insufficiency (POI) when there is a familial disposition or to postpone menopause in patients with an increased risk of osteoporosis or cardiovascular diseases. The benefit of OTC beyond fertility requires, however, actual clinical studies. The current review includes several recent technical aspects with contributions from Denmark building on some of the early work by Roger Gosden.

Download Full-text

Consequences of β-Thalassemia or Sickle Cell Disease for Ovarian Follicle Number and Morphology in Girls Who Had Ovarian Tissue Cryopreserved

Frontiers in Endocrinology ◽

10.3389/fendo.2020.593718 ◽

2021 ◽

Vol 11 ◽

Author(s):

Linn Salto Mamsen ◽

Stine Gry Kristensen ◽

Susanne Elisabeth Pors ◽

Jane Alrø Bøtkjær ◽

Erik Ernst ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Prediction Interval ◽

Reference Group ◽

Ovarian Tissue ◽

Ovarian Follicle ◽

Ovarian Tissue Cryopreservation ◽

Cell Disease ◽

Ovarian Insufficiency ◽

Tissue Cryopreservation

Women with β-thalassemia (BT) and sickle cell disease (SCD) have a high risk of infertility and premature ovarian insufficiency. Different fertility preserving strategies, including ovarian tissue cryopreservation (OTC) and oocyte cryopreservation has been considered, and healthy babies have been born after successful OTC and transplantation. We evaluated follicle number and follicle health in ovarian tissue from a cohort of BT and SCD patients who underwent OTC before the age of 18 years. Patients undergoing OTC from 2002 to 2019 were included. A total of 14 girls and adolescents with BT and four with SCD, aged 2.8–17.4 years at OTC were included together with a reference group of 43 girls and adolescents with non-anemia diseases considered to have normal ovaries aged 0.6–17.9 years at OTC. Ovarian follicle density was measured in cortex biopsies and compared to the reference group. Expression of proteins associated with follicular health was evaluated using immunohistochemistry. Follicles were detected in the ovarian cortex biopsies from all patients with BT and SCD. The follicle densities were within the 95% prediction interval of the reference group in all cases. A similar expression of six proteins essential for follicular health was detected using immunohistochemistry in BT, SCD, and references. OTC should be considered an option for young girls and adolescents with BT and SCD.

Download Full-text

Premature Ovarian Insufficiency After Bone Marrow Transplantation for Thalassemia Major in a Patient With Primary Amenorrhea and 46, XY Karyotype: a Case Report and Literature Review

10.21203/rs.3.rs-154411/v1 ◽

2021 ◽

Author(s):

Hui Li ◽

Jin Li ◽

Xiaohong Li ◽

Hong Yi ◽

Qixiu Ren ◽

...

Keyword(s):

Bone Marrow ◽

Case Report ◽

Bone Marrow Transplant ◽

Marrow Transplant ◽

Premature Ovarian Insufficiency ◽

Sex Characteristics ◽

Primary Amenorrhea ◽

Thalassaemia Major ◽

Ovarian Insufficiency ◽

Detailed Medical History

Abstract Background: Iatrogenic factor is one of the recognized causes for premature ovarian insufficiency. The aim of this case report was to present a rare case with premature ovarian insufficiency and 46, XY karyotype after bone marrow transplant for thalassaemia major at childhood. We also reviewed some relevant literature in this report.Case presentation: A 17-year-old girl was presented with primary amenorrhea and premature ovarian insufficiency after receiving chemotherapy and bone marrow therapy from her brother due to thalassaemia major at childhood. She had poor secondary sex characteristics, assessed as stage I for the development of breasts and external genitalia based on the Tanner scale. Transabdominal ultrasound showed small uterus with visible endometrial lining and small ovaries. Laboratory data showed hypergonadotropic hypogonadism profile with low level of estrogen and high level of follicular-stimulating hormone (FSH). Patient’s peripheral lymphocytes karyotype was 46, XY. Conclusions: A correct diagnosis is not only dependent on clinical manifestations, but also the detailed medical history. In light of the relatively high prevalence of thalassemia, fertility preservation should be considered for young girls before they receive chemotherapy, radiation treatment and bone marrow transplant.

Download Full-text