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A retrospective study of ovarian tissue cryopreservation in female patients with hematological diseases for fertility preservation

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purposes

To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases.

Methods

We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People’s Hospital from April 2017 to January 2023 were analyzed and summarized.

Results

A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81 years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12 ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24 IU/L in examination before OTC. FSH was greater than 10.0 IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84 g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43 g/L, and the average platelet was (156.38 ± 103.22) × 109/L.

Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58 min, and the average blood loss was 32.1 ± 41.6 mL. The maximum blood loss was 200 mL.

There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20 days and began HSCT within 30 days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3 years after HSCT and resumed regular menstruation 6 months after OTT.

Conclusions

Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.

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Data availability

Data will be available on request.

Abbreviations

MDS:

Myelodysplastic syndromes

AA:

Aplastic anemia

CAMT:

Congenital amegakaryocytic thrombocytopenia

ALL:

Acute lymphoblastic leukemia

AML:

Acute myeloid leukemia

HSCT:

Hematopoietic stem cell transplantation

OTC:

Ovarian tissue cryopreservation

CAR-T:

Chimeric antigen receptor T-cell immunotherapy

CMML:

Chronic myelomonocytic leukemia

SPSS:

Specific prognostic scoring system

HPO:

Hypothalamic-pituitary-ovarian

AMH:

Anti-mullerian hormone

rhG-CSF:

Recombinant human granulocyte colony stimulating factor

FSH:

Follicle-stimulating hormone

LH:

Luteinizing hormone

OTT:

Ovarian tissue transplantation

WBC:

White blood cell

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Funding

This work was supported by “Natural Science Foundation of Beijing Municipality” (No: 7222206).

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Author notes

  1. Yi-Ling Wang and Qing-Jie Zhai contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Peking University People’s Hospital, Peking University, Beijing, 100044, China

    Yi-Ling Wang, Qing-Jie Zhai, Zhao-Hua Wang, Xin Yang, Jian-Liu Wang & Hong-Lan Zhu

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Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

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Correspondence to Hong-Lan Zhu.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Peking University People’s Hospital Ethics Committee (2024PHB042-001).

Consent to participate

This study is a retrospective study and informed consent had been waived by Ethics Committee of Peking University People’s Hospital.

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Wang, YL., Zhai, QJ., Wang, ZH. et al. A retrospective study of ovarian tissue cryopreservation in female patients with hematological diseases for fertility preservation. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07484-4

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