Live birth in a woman without ovaries after autograft of frozen-thawed ovarian tissue combined with growth factors

Justo Callejo, Cristina Salvador, Santiago González-Nuñez, Laura Almeida, Luciano Rodriguez, Laura Marqués, Ana Valls, José Maria Lailla, Justo Callejo, Cristina Salvador, Santiago González-Nuñez, Laura Almeida, Luciano Rodriguez, Laura Marqués, Ana Valls, José Maria Lailla

Abstract

Currently, cryopreservation of oocytes, embryos and ovarian tissue is considered the basis of fertility preservation programs for women with cancer and other diseases who are rendered sterile by gonadotoxic drugs or radiation.Numerous studies have confirmed that autograft of frozen-thawed ovarian tissue can restore ovarian function and fertility. A total of twenty-two live births have been reported but we still have to consider this technique as experimental. The main problem is that the implant undergoes ischemia until neoangiogenesis is restored, resulting in significant follicular loss.At the moment, there are numerous publications in different medical fields that publish successful experiences with plasma rich in platelets (PRP) in different clinical situations promoting angiogenesis. Thus, we considered the possibility of using it in the field of ovarian autologous transplantation in order to improve the vascularization of the implant and its quality. For this, both thawed ovarian tissue as practiced pockets on the rear side of the broad ligament which have been placed, have been impregnated with PRP. We can say that the implant treated in this way has had a rapid and successful response.We report a special interesting case because this is the first time that this technique is performed successfully in a woman without ovaries combined with growth factors to promote neoangiogenesis. Obviously, the results of the hormonal response come exclusively from the implanted tissue in these special conditions.

Figures

Figure 1
Figure 1
The surgical procedure is extremely easy. The thawed ovarian tissue (A) is impregnated in a gel preparation of PRP (B) and it is transferred using laparoscopic surgery to the pockets located in the posterior surface of the broad ligaments (C).
Figure 2
Figure 2
Peripheral hormones levels of FSH, estradiol, Progesterone, HCG, AMH and Inhibin B, from the first menstruation until the first positive HCG determination.
Figure 3
Figure 3
Peripheral hormones levels of FSH, estradiol, Progesterone, HCG, AMH and Inhibin B, during pregnancy and immediate pospartum.

References

    1. Donnez J, Jadoul P, Pirard C, Hutchings G, Demylle D, Squifflet J, Smitz J, Dolmans MM. Live birth after transplantation of frozen-thawed ovarian tissue after bilateral oophorectomy for benign disease. Fertil Steril. 2012;98(3):720–725. doi: 10.1016/j.fertnstert.2012.05.017.
    1. Revelli A, Marchino G, Dolfin E, Molinari E, Delle Piane L, Salvagno F, Benedetto C. Live birth after orthotopic grafting of autologous cryopreserved ovarian tissue and spontaneous conception in Italy. Fertil Steril. 2013;99(1):227–230. doi: 10.1016/j.fertnstert.2012.09.029.
    1. Isachenki V, Isachenki E, Keck G, Dittrich R, Montag M, van der Ven H, Mallmann P, Müller A, Distler W, Beckmann MW, Rahimi G. First live birth in Germany after re-transplantation of cryopreserved ovarian tissue: original device for initiation of ice formation. Clin Lab. 2012;58(9–10):933–938.
    1. Baird DT, Webb R, Campbell BK, Harkness LM, Gosden RG. Long-term ovarian function in sheep after ovariectomy and transplantation of autografts stored at −196 C. Endocrinology. 1999;140(1):462–471. doi: 10.1210/en.140.1.462.
    1. Nisolle M, Casanas-Roux F, Qu J, Motta P, Donnez J. Histologic and ultraestructural evaluation of fresh and frozen-thawed human ovarian xenografts in nude mice. Fertil Steril. 2000;74(1):122–129. doi: 10.1016/S0015-0282(00)00548-3.
    1. Donnez J, Dolmans MM, Demylle D, Jadoul P, Pirard C, Squifflet J, Martinez-Madrid B, van Langendonckt A. Restoration of ovarian function after orthotopic (intraovarian and periovarian) transplantation of cryopreserved ovarian tissue in a woman treated by bone marrow transplantation for sickle cell anaemia: case report. Hum Reprod. 2006;21:183–188.
    1. Callejo J, Salvador C, Miralles A, Vilaseca S, Lailla JM, Balasch J. Long-term ovarian function evaluation after autografting by implantation with fresh and frozen-thawed human ovarian tissue. J Clin Endocrinol Metab. 2001;86:4489–4494. doi: 10.1210/jc.86.9.4489.
    1. Bosch G, Moleman M, Barneveld A, van Weeren PR, van Schie HT. The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports. 2011;21(4):554–561. doi: 10.1111/j.1600-0838.2009.01070.x.
    1. Roy S, Driggs J, Elgharably H, Biswas S, Findley M, Khanna S, Gnyawali U, Bergdall VK, Sen CK. Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair Regen. 2011;19(6):753–766. doi: 10.1111/j.1524-475X.2011.00740.x.
    1. El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M, van Dyke TE. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007;78(4):661–669. doi: 10.1902/jop.2007.060302.
    1. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med. 2011;39(10):2135–2140. doi: 10.1177/0363546511417792.
    1. Anitua E, Andia I, Ardanza B, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;92:1–12.
    1. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-Rich Plasma: From Basic Science to Clinical Applications. Am J Sports Med. 2009;37:2259–2263. doi: 10.1177/0363546509349921.
    1. Anitua E, Alkhraisat MH, Orive G. Perspectives and challenges in regenerative medicine using plasma rich in growth factors. J Control Release. 2012 Jan 10;157(1):29–38. doi: 10.1016/j.jconrel.2011.07.004.
    1. Yu W, Wang J, Yin J. Platelet-rich plasma: a promising product for treatment of peripheral nerve regeneration after nerve injury. Int J Neurosci. 2011;121(4):176–180. doi: 10.3109/00207454.2010.544432.
    1. Everts PA, Hoogbergen MM, Weber TA, Devilee RJ, van Monftort G, de Hingh IH. Is the Use of Autologous Platelet-Rich Plasma Gels in Gynecologic, Cardiac, and General, Reconstructive Surgery Beneficial? Curr Pharm Biotechnol. 2011;13(7):1163–1172.
    1. Andersen CY, Rosendahl M, Byskov AG, Loft A, Ottosen C, Dueholm M, Schmidt KL, Andersen AN, Ernst E. Two successful pregnancies following autotransplantation of frozen/thawed ovarian tissue. Hum Reprod. 2008;23(10):2266–2272. doi: 10.1093/humrep/den244.
    1. Meirow D, Levron J, Eldar-Geva T, Hardan I, Fridman E, Zalel Y, Schiff E, Dor J. Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med. 2005;353(3):318–321. doi: 10.1056/NEJMc055237.
    1. Janse F, Donnez J, Anckaert E, de Jong FH, Fauser BC, Dolmans MM. Limited value of ovarian function markers following orthotopic transplantation of ovarian tissue after gonadotoxic treatment. J Clin Endocrinol Metab. 2011;96:1136–1144. doi: 10.1210/jc.2010-2188.
    1. Greve T, Schmidt K, Kristensen SG, Ernst E, Andersen CY. Evaluation of the ovarian reserve in women transplanted with frozen and thawed ovarian cortical tissue. Fertil Steril. 2012;97:1395–1398.
    1. Callejo J, Vilaseca S, Ordi J, Cabré S, Lailla JM, Balasch J. Heterotopic ovarian transplantation without vascular pedicle in syngeneic Lewis rats: long-term evaluation of effects on ovarian structure and function. Fertil Steril. 2002;77(2):396–402. doi: 10.1016/S0015-0282(01)02970-3.
    1. Callejo J, Vilaseca S, Medina M, Salvador C, Valls C, Lailla JM. Inhibin and follicle development in heterotopical transplant of ovary without vascular pedicle in syngeneic Lewis rats. Fertil Steril. 2003;79(1):743–748.
    1. Oktay K, Buyuk E, Veeck L, Zaninovic N, Xu K, Takeuchi T. Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet. 2004;363(9412):837–840. doi: 10.1016/S0140-6736(04)15728-0.
    1. Demeestere I, Simon P, Buxant F, Robin V, Fernandez Aguilar S, Centner J, Delbaere A, Englert Y. Ovarian function and spontaneous pregnancy after combined heterotopic and orthotopic cryopreserved ovarian tissue transplantation in a patient previously treated with bone marrow transplantation. Hum Reprod. 2006;21(8):2010–2014. doi: 10.1093/humrep/del092.
    1. Demeestere I, Simon P, Emiliani S, Delbaere A, Englert Y. Fertility preservation: Successful transplantation of cryopreserved ovarian tissue in a young patient previously treated for Hodgkin’s disease. Oncologist. 2007;12:1437–1442. doi: 10.1634/theoncologist.12-12-1437.

Source: PubMed

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