The report of ovarian tissue transplant in Iran: A case report

Abstract

Background: Cancer treatments such as chemotherapy and radiotherapy increase the chance of ovarian failure. Ovarian tissue transplantation (OTT) is a viable option for fertility preservation in these cases. We aim to report ovarian transplantation in a leukemia case undergoing the vitrification method.


Case Presentation: The case was a 28-yr-old female in Research and Clinical Center for Infertility, Yazd, Iran who was suffering from leukemia. Ovarian biopsy was performed by laparoscopy surgery and transported to cryopreservation lab at 4°C for 1–2 hr. The ovarian cortex was removed from the medulla, and ovarian strips were cryopreserved by vitrification. This procedure used the equilibration and vitrification solutions including medium 199 supplemented with 20% serum, and ethylene glycol and dimethyl sulfoxide with concentrations of 7.5% and 20%, respectively. Before doing OTT, we assessed the tissue viability and follicular count by chick embryo chorioallantoic membranes and histologic survey, respectively. OTT was done after complete remission, following warmed tissue sutured together and transplanted on the residual medulla on the right side. On the left side, the ovary was removed completely; however, 2 strips were put on the peritoneal pocket. Anti-Müllerian hormone, follicle-stimulating hormone, and luteinizing hormone levels were 0.1 ng/mL, 36.5 mIU/mL, and 19.8 mIU/mL before OTT. During a 6-month follow-up, the anti-Müllerian hormone increased to 0.9, and then follicle-stimulating hormone and luteinizing hormone levels decreased dramatically until 17.47 mIU/mL and 6.71 mIU/mL, respectively. Also, the patient had 3 cycles of menstrual periods.


Conclusion: We demonstrated an appropriate hormonal profile, and the restoration of the menstrual cycle might indicate a successful transplant. Further investigations are needed to achieve successful clinical outcomes.


Key words: Cryopreservation, Tissue transplantation, Leukemia, Vitrification, Ovarian follicle.

References
[1] Diaz AA, Kubo H, Handa N, Hanna M, Laronda MM. A systematic review of ovarian tissue transplantation outcomes by ovarian tissue processing size for cryopreservation. Front Endocrinol 2022; 13: 918899.

[2] Kometas M, Christman GM, Kramer J, Rhoton-Vlasak A. Methods of ovarian tissue cryopreservation: Is vitrification superior to slow freezing? Ovarian tissue freezing methods. Reprod Sci 2021; 28: 3291–3302.

[3] Eftekhar M, Pourmasumi S, Karimi-Zarchi M. Preservation of ovarian function during chemotherapy and radiotherapy in young women with malignancies. Iran J Reprod Med 2014; 12: 377–382.

[4] Shapira M, Raanani H, Barshack I, Amariglio N, Derech- Haim S, Marciano MN, et al. First delivery in a leukemia survivor after transplantation of cryopreserved ovarian tissue, evaluated for leukemia cells contamination. Fertil Steril 2018; 109: 48–53.

[5] Anbari F, Khalili MA, Mahaldashtian M, Ahmadi A, Palmerini MG. Fertility preservation strategies for cancerous women: An updated review. Turk J Obstet Gynecol 2022; 19: 152– 161.

[6] Labrune E, Jaeger P, Santamaria C, Fournier C, Benchaib M, Rabilloud M, et al. Cellular and molecular impact of vitrification versus slow freezing on ovarian tissue. Tissue Eng Part C Methods 2020; 26: 276–285.

[7] Dolmans M-M, von Wolff M, Poirot C, Diaz-Garcia C, Cacciottola L, Boissel N, et al. Transplantation of cryopreserved ovarian tissue in a series of 285 women: A review of five leading European centers. Fertil Steril 2021; 115: 1102–1115.

[8] Kagawa N, Silber Sh, Kuwayama M. Successful vitrification of bovine and human ovarian tissue. Reprod Biomed Online 2009; 18: 568–577.

[9] Vatanparast M, Maleki B, Khalili MA. Ischemia and vasculogenesis after transplantation of frozen and vitrified human ovarian tissue onto chick embryo chorioallantoic membrane (CAM). Eur J Obstet Gynecol Reprod Biol 2023; 284: 94–99.

[10] Lee S, Ozkavukcu S, Ku SY. Current and future perspectives for improving ovarian tissue cryopreservation and transplantation outcomes for cancer patients. Reprod Sci 2021; 28: 1746–1758.

[11] Vatanparast M, Karimi Zarchi M, Nabi A, Khalili MA. Proliferating cell nuclear antigen presentation, as a marker of folliculogenesis, in the transplanted ovarian tissue. J Obstet Gynaecol Res 2021; 47: 4340–4349.

[12] Shi Q, Xie Y, Wang Y, Li S. Vitrification versus slow freezing for human ovarian tissue cryopreservation: A systematic review and meta-anlaysis. Sci Rep 2017; 7: 8538.

[13] Wang Y, Xiao Z, Li L, Fan W, Li SW. Novel needle immersed vitrification: A practical and convenient method with potential advantages in mouse and human ovarian tissue cryopreservation. Hum Reprod 2008; 23: 2256– 2265.

[14] Lotz L, Dittrich R, Hoffmann I, Beckmann MW. Ovarian tissue transplantation: Experience from Germany and worldwide efficacy. Clin Med Insights Reprod Health 2019; 13: 1179558119867357.

[15] Vatanparast M, Moshrefi M, Yari N, Khalili MA, Macchiarelli G, Palmerini MG. Effective dosage of growth differentiation factor-9?? in folliculogenesis and angiogenesis in the sheep ovarian tissues grafted onto chick embryo chorioallantoic membrane. J Obstet Gynaecol Res 2020; 46: 1384–1392.

[16] Karimi-Zarchi M, Khalili MA, Binesh F, Vatanparast M. Ovarian tissue reservation and risk of reimplantation in a young girl with acute lymphocytic leukemia after 6-month chemotherapy: A case report. South Asian J Cancer 2021; 10: 112–114.

[17] Von Wolff M, Nawroth F. Fertility preservation in oncological and non-oncological diseases: A practical guide. 1st Ed. Cham: Springer; 2020.

[18] Poirot C, Fortin A, Lacorte JM, Akakpo JP, Genestie C, Vernant JP, et al. Impact of cancer chemotherapy before ovarian cortex cryopreservation on ovarian tissue transplantation. Hum Reprod 2019; 34: 1083–1094.

[19] Rodriguez-Wallberg KA, Milenkovic M, Papaikonomou K, Keros V, Gustafsson B, Sergouniotis F, et al. Successful pregnancies after transplantation of ovarian tissue retrieved and cryopreserved at time of childhood acute lymphoblastic leukemia: A case report. Haematologica 2021; 106: 2783–2787.