Reproductive and Endocrine Outcomes in a Cohort of Danish Women following Auto-Transplantation of Frozen/Thawed Ovarian Tissue from a Single Center

SIMPLE SUMMARY: Ovarian tissue cryopreservation and transplantation is a method used to restore fertility in women with ovarian insufficiency after chemotherapy or irradiation. However, usage of the preserved tissue is low, and more data are needed to identify the strengths and weaknesses of the procedures, allowing for us to improve all steps, from patient selection, surgical and laboratory techniques, protocols for fertility treatment and, finally, live birth rates after ovarian tissue transplantation. This study reports the reproductive outcome and hormonal recovery following ovarian tissue transplantation and evaluates possible predictors of the chance of pregnancy in a cohort of 40 women from a single experienced center in Denmark. ABSTRACT: Ovarian tissue cryopreservation (OTC) is a method of fertility preservation in girls and young women prior to gonadotoxic treatment. It is a safe and promising method to restore fertility. The initial recovery of endocrine function is high, but the longevity of the grafted tissue varies. In this single-center, combined retro- and prospective cohort study, we report the reproductive outcome and hormonal recovery following ovarian tissue transplantation (OTT) and evaluate possible predictors of the chance of pregnancy. The study includes 40 women from eastern Denmark undergoing 53 OTTs between 2003 and 2021. Permission to obtain retrospective data was given by the Danish Patient Safety Authorities and prospective data-collection by informed consent. Initial recovery of endocrine function was seen in 18/19 women with POI, and ongoing function of the grafted tissue in 7/14 two years from OTT. Live birth rate (LBR) was 41%, with 20 children to 39 women trying to conceive. Women who conceived had higher AFC at the time of OTC than women who did not (p ± 0.04). Repeated transplantations were not successful in terms of delivery. Half of all pregnancies were achieved by ART, but PRs were lower after ART than by spontaneous conception. LBRs after OTT are encouraging. Chance of pregnancy after OTT is correlated to ovarian reserve at OTC. Repeated transplantations were not successful in terms of unfulfilled pregnancy wish.