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Monitoring the ovaries after autotransplantation of cryopreserved ovarian tissue: endocrine studies, in vitro fertilization cycles, and live birth  Dror.

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Presentation on theme: "Monitoring the ovaries after autotransplantation of cryopreserved ovarian tissue: endocrine studies, in vitro fertilization cycles, and live birth  Dror."— Presentation transcript:

1 Monitoring the ovaries after autotransplantation of cryopreserved ovarian tissue: endocrine studies, in vitro fertilization cycles, and live birth  Dror Meirow, M.D., Jacob Levron, M.D., Talia Eldar-Geva, Ph.D., M.D., Izhar Hardan, M.D., Eduard Fridman, M.D., Ziva Yemini, M.Sc., Jehoshua Dor, M.D.  Fertility and Sterility  Volume 87, Issue 2, Pages 418.e7-418.e15 (February 2007) DOI: /j.fertnstert Copyright © 2007 American Society for Reproductive Medicine Terms and Conditions

2 FIGURE 1 Timescale (months) from diagnosis to high-dose chemotherapy and stem cell support, showing chemotherapy protocols, menstrual cycles, and fertility preservation procedures. OTCP, ovarian tissue cryopreservation; OCP, oral contraception pills; SCT, high-dose chemotherapy and stem cell support. First-line chemotherapy protocol (VACOP-B): etoposide, adriamycin, cyclophosphamide, vincristine, bleomycin, and steroids. Second-line chemotherapy protocol (MINE/ESHAP): mesna, ifosfamide, mitoxantrone, etoposide, Ara-C, cis-platinum, and steroids (11). High-dose chemotherapy (BEAM): BCNU 300 mg/sm, etoposide 1600 mg/sm, Ara-C 1600 mg/sm, and melphalan 140 mg/sm. Meirow. Birth after ovarian tissue transplantation. Fertil Steril 2007. Fertility and Sterility  , 418.e7-418.e15DOI: ( /j.fertnstert ) Copyright © 2007 American Society for Reproductive Medicine Terms and Conditions

3 FIGURE 2 Ovarian histology. (A) Ovarian tissue harvested for cryopreservation 5 weeks after second chemotherapy course. A large number of primordial follicles (>150 mm3) with normal architecture are present. Original magnification, ×100. (B) Two primordial follicles after freezing-thawing procedure showing normal morphology. Original magnification, ×400. (C) Samples of ovarian tissue 2 years after high-dose chemotherapy, removed during the surgery to transplant ovarian tissue, show cortical atrophy. No follicles are present. Original magnification, ×20. Meirow. Birth after ovarian tissue transplantation. Fertil Steril 2007. Fertility and Sterility  , 418.e7-418.e15DOI: ( /j.fertnstert ) Copyright © 2007 American Society for Reproductive Medicine Terms and Conditions

4 FIGURE 3 Estradiol (E2) levels, inhibin B levels, and follicle diameter in the second month (A), third month (B), eighth month (C), and ninth month (D) after ovarian tissue transplantation. Inhibin B is presented in squares (■) and points connected in dashed lines. Levels of E2 are presented in triangles (▲) and solid lines connect the points during follicular phase. At the eighth and ninth months (C, D), hormone levels are also presented during luteal phase. In the third and the ninth months (B, D), the ovaries were stimulated. Follicles with diameter of 19 to 22 mm developed in all cycles; however, inhibin B levels were low during the second, third, and eighth months (A, B, C) and did not correlate with follicular size. Only in the ninth month were inhibin B levels high and showed normal pattern of rise and fall during follicle growth. In this cycle, an egg was retrieved (D). Meirow. Birth after ovarian tissue transplantation. Fertil Steril 2007. Fertility and Sterility  , 418.e7-418.e15DOI: ( /j.fertnstert ) Copyright © 2007 American Society for Reproductive Medicine Terms and Conditions

5 FIGURE 4 (A) Transvaginal ultrasonography 8 months after transplantation demonstrating the left ovary, measuring 30 × 24 mm with a follicle of 18 mm in diameter. Doppler flow in the periphery of the follicle revealed normal vascularization, Resistance Index (RI) = (B) Four-cell embryo on day 2 after fertilization, prior to embryo transfer. (C) Transvaginal ultrasound at 10 weeks gestation, demonstrating a single fetus with a Crown to Rump Length (CRL) of 35 mm. Meirow. Birth after ovarian tissue transplantation. Fertil Steril 2007. Fertility and Sterility  , 418.e7-418.e15DOI: ( /j.fertnstert ) Copyright © 2007 American Society for Reproductive Medicine Terms and Conditions


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