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• W4253852010 abstract "As the perinatologists responsible for managing the first pregnancy after cryopreserved ovarian tissue autotransplantation reported by J Donnez and colleagues, 1Donnez J Dolmans MM Demylle D et al.Livebirth after orthotopic transplantation of cryopreserved ovarian tissue..Lancet. 2004; 364: 1405-1410Summary Full Text Full Text PDF PubMed Scopus (1373) Google Scholar we faced several clinical uncertainties. Since this technique might become part of clinical practice, we feel that the prenatal findings and neonatal follow up should be made available to clinicians. Although the patient was not particularly at risk of aneuploidy due to her age (31 years), the complex technical handling and storage conditions endured by her embryos warranted careful observation. Oktay and colleagues2Oktay K Buyuk E Veeck L et al.Embryo development after heterotopic transplantation of cryopreserved ovarian tissue..Lancet. 2004; 363: 837-840Summary Full Text Full Text PDF PubMed Scopus (491) Google Scholar reported, among two embryos developed after a heterotopic ovarian tissue graft, one with aneuploidy. The results of our patient's first trimester nuchal translucency test were negative, but at 16 weeks the triple test indicated the baby had a one in 236 chance of being born with Down's syndrome. Since the test has a false positive rate of about 5%, we did a detailed ultrasound—eg, nasal bone and ear measurement, femur length, anatomical screening—which showed none of the signs associated with chromosomal anomalies. After discussion with the parents, an amniocentesis was not done because of the risk of miscarriage associated with the procedure. Postnatal rapid karyotyping on lymphocyte culture showed no signs of aneuploidy. Another concern was risk of growth impairment and morbidity associated with the quality of the oocytes and the corpus luteum. Results of some in-vivo and in-vitro studies have indicated abnormal oocyte characteristics after ovarian transplant. Sato and colleagues3Sato Y Terada Y Utsunomiya H et al.Immunohistochemical localization of steroidogenic enzymes in human follicle following xenotransplantation of human ovarian cortex into NOD-SCID mice..Mol Reprod Dev. 2003; 65: 67-72Crossref PubMed Scopus (9) Google Scholar noted, in human follicles transplanted into NOD-SCID mice, that although the expression of steroidogenic enzymes was normal they did not possess the characteristics of dominant follicles. Furthermore, ovarian tissue grafts in sheep were associated with an increased neonatal mortality.4Salle B Demerci B Franck M Berthollet C Lornage J Long term follow up of cryopreserved hemi-ovary autografts in ewes: pregnancies, births and histological assessment..Fertil Steril. 2003; 80: 172-177Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar In terms of fetal growth, animal data show that litter sizes are normal after implantation of fresh or cryopreserved ovaries.5Lee DM Yeoman RR Battaglia DE et al.Live birth after ovarian tissue transplant..Nature. 2004; 428: 137-138Crossref PubMed Scopus (162) Google Scholar To supplement a possible corpus luteum deficiency, we administered micronised progesterone vaginally during the first trimester. Fetal growth was normal and even increased during the third trimester, with ultrasound features of macrosomia and mild polyhydramnios. Results of screening for gestational diabetes were negative. However, because of the large size of the fetus, labour was induced at 38 weeks and forceps were used after 30 min of inefficient pushing. The risk of cancer recurring and spreading through the ovarian graft even after remission, and the conflicting results published on procedure safety have been discussed by Donnez and colleagues. In our patient, a postpartum Hodgkin's disease check up is planned, but we noted no abnormal cells in the placental samples screened with a specific staining technique. The newborn is healthy. She had a slight heart murmur, but echocardiography was normal. Ovarian cryopreservation therefore represents a promising option for women diagnosed with cancer. Despite our concerns, the outcome of this pregnancy suggests that ovarian steroid–hormone support was adequate for placental development. Aneuploidy and recurrence of cancer through activation of micrometastases were not seen in this case, but long-term follow up and large series studies should be done." @default.
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• W4253852010 date "2004-12-01" @default.
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• W4253852010 title "Livebirth after cryopreserved ovarian tissue autotransplantation" @default.
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• W4253852010 doi "https://doi.org/10.1016/s0140-6736(04)17543-0" @default.
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