Successful pregnancy and birth following avascular micro ovarian tissue orthotopic transplantation in a patient with hodgkins disease

To present a case of a successful birth following orthotopic reimplantation of avascular micro slices of ovarian tissue in a parient who underwent fertility preservation by means of ovarian tissue cryopreservation (OTCP) prior to chemotherapy for Hodgkins disease. Case report. A 28-years age single patient underwent partial oophorectomy and cryopreservation of ovarian tissue prior to chemotherapy by adriamycin ,bleomycin,vinblastine and dacarbazine ABVD protocol for Hodgkins disease. Four years later she had recurrence of her disease and because of that she underwent bone marrow transplantation, and was treated by sterilizing chemotherapy, which resulted in premature ovarian failure. At the age of 38 she underwent autologous avascular reimplantation of micro-slices of the ovarian tissue through incision in the right peritoneal pocket which was closed by using aicril 3/0 running sutures. The micro-slices were prepared by using a specially designed apparutus (Micritome). Sixty days after the reimplantation, we expected a 18 mm diameter follicle located in the area of the implantation, the blood estradiol level was 220 pgm/ml, progesterone 0.3 pgm/ml, FSH- 4.7 U/L and LH 4.1 U/L. An injection of recombinant hCG (Ovitrelle) was given and a mature oocyte was retreived. We performed conventional fertilization and a 4 -cell embryo was transferred at day 2, pregnancy was documented 12 days later. The course of pregnancy was uneventful and the patient deliverd at term by cesarean section a healthy baby. This case report demonstrates that avascular ortotopic micro-organ transplantation is a feasible option for reimplantation of cryopreserved/thawed ovarian tissue. Resumption of ovarian function may be early as 60 days after reimplantation compared 3-6 months to cases in which vascular transplantation of ovarian tissue was performed. Furthermore OTCP should be considered prior to administration of gonadotoxig druges are administered.