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First pregnancy and live birth in Turkey following frozen-thawed ovarian tissue transplantation in a patient with acute lymphoblastic leukemia who underwent cord blood transplantation.
Journal of Assisted Reproduction and Genetics ( IF 3.1 ) Pub Date : 2020-06-16 , DOI: 10.1007/s10815-020-01850-2
Murat Sonmezer 1 , Sinan Ozkavukcu 1, 2 , Yavuz Emre Sukur 1 , Duygu Kankaya 3 , Onder Arslan 4
Affiliation  

Purpose

To report the first live birth after frozen-thawed ovarian transplantation in Turkey and the second case for an acute lymphoblastic leukemia (ALL) survivor in the world.

Methods

A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels > 100 IU/ml and estradiol < 20 pg/ml and hematologically in molecular remission. Detailed molecular analysis, standard histology, and immunohistochemistry demonstrated that the thawed tissue is free of malignant cells.

Results

Six months following OTT, she had spontaneous menstruation with serum FSH 11 IU/ml and estradiol 53 pg/ml. Two consecutive IVF cycles yielded three top-quality embryos. Following three embryo transfer cycles, one fresh and two frozen, a healthy term live birth was achieved. Frozen-thawed-transplanted tissues were extracted during caesarean delivery upon the patient’s request after a total period of 25 months in vivo, and histopathological evaluation revealed that the tissue was free of leukemic infiltration.

Conclusion

The authors report the first pregnancy and live birth in Turkey and the second live birth in the world following transplantation of frozen-thawed ovarian tissue in a leukemia survivor. As the transplanted tissues were removed during caesarean delivery, histological findings prove the functionality and the malignant-free status of the transplanted tissue during the grafted period.



中文翻译:

土耳其一名接受脐带血移植的急性淋巴细胞白血病患者冷冻解冻卵巢组织移植后首次怀孕和活产。

目的

报告土耳其冻融卵巢移植后的第一例活产和世界上第二例急性淋巴细胞白血病 (ALL) 幸存者。

方法

一名 19 岁的患者在 2010 年脐带血移植前接受了卵巢组织冷冻保存 (OTC)。她被诊断为 ALL,骨髓活检显示 90% 原始细胞 ALL-L2 型,核型分析表明在 t(9 ;22)(q34;q11)。患者接受了柏林-法兰克福-明斯特 (BFM) 方案,在保留生育能力之前实现了完全缓解。血清 AMH 水平测量为 1.5 ng/ml,超声计数 12 个窦卵泡。在 2011 年 4 月脐带血移植前,她被告知保留生育能力的选择并决定进行 OTC,并在她签署同意书的情况下进行。 卵巢组织移植 (OTT) 于 2017 年进行,当时患者处于绝经期,血清 FSH 水平 > 100 IU/ml和雌二醇 < 20 pg/ml 和血液学分子缓解。详细的分子分析、标准组织学和免疫组织化学表明,解冻的组织没有恶性细胞。

结果

OTT 后 6 个月,她出现了自发性月经,血清 FSH 为 11 IU/ml,雌二醇为 53 pg/ml。两个连续的试管婴儿周期产生了三个高质量的胚胎。经过三个胚胎移植周期,一个新鲜的和两个冷冻的,实现了健康的足月活产。在体内总共25个月后,在剖宫产期间根据患者的要求提取冷冻解冻移植组织,组织病理学评估显示该组织没有白血病浸润。

结论

作者报告了土耳其第一次怀孕和活产,以及在白血病幸存者移植冻融卵巢组织后世界上第二次活产。由于在剖腹产期间移植的组织被移除,组织学结果证明移植组织在移植期间的功能性和无恶性状态。

更新日期:2020-06-16
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