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Autologous transplantation of cryopreserved ovarian tissue to induce puberty—the endocrinologists’ view

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Abstract

Transplantation of cryopreserved ovarian tissue has been shown to successfully induce pregnancies. Furthermore, puberty may be induced by transplanted ovarian tissue in girls suffering from premature primary ovarian insufficiency (PPOI) due to gonadotoxic therapy. Therefore, the question arises if ovarian tissue cryopreservation should be recommended for puberty induction in prepubertal girls with cancer prior to gonadotoxic therapies. Although this strategy seems to be more natural than administering exogenous steroid sex hormones, there are some disadvantages from the endocrinological point of view. During physiologic puberty, serum estradiol levels increase very slowly, followed by irregular and finally regular ovulations with progesterone production during the luteal phase. PPOI presents as hypergonadotrophic hypogonadism. When transplanting ovarian tissue in girls with PPOI, the elevated gonadotrophins will promote a sudden follicular growth of one or several follicles with a sharp increase of serum estrogen levels and regular ovulations. This will result into an accelerated pubertal development with the risk of overt weight gain, cutaneous striae and premature growth stop possibly leading to psychological implications.

Conclusion: Transplantation of cryopreserved ovarian tissue should not be recommended as an alternative to medically induced puberty.

What is Known:

• Ovarian tissue is increasingly cryopreserved before cytotoxic therapies.

• Ovarian tissue has been transplanted not only to generate pregnancies but also in induce puberty in children with ovarian failure.

What is New:

• Ovarian tissue transplantation in hypergonadotropic adolescents result in a sudden increase of estradiol concentration and an unphysiological fast puberty induction.

• Puberty induction by transplanted ovarian tissue appear to be a natural approach but it is not and should therefore not be performed.

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Abbreviations

PPOI:

Premature primary ovarian insufficiency

FSH:

Follicle stimulation hormone

LH:

Luteinizing hormone

GnRH:

Gonadotropin releasing hormone

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Acknowledgments

Contributions of the authors

M. von Wolff designed the paper and included the technical aspects of ovarian tissue transplantation.

Petra Stute added the gynaecologic endocrinological aspects.

C. Flueck added the pediatric endocrinological aspects.

All authors revised and accepted the final manuscript.

Author information

Authors and Affiliations

  1. Division of Gynecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Effingerstrasse 102, 3010, Bern, Switzerland

    Michael von Wolff & Petra Stute

  2. Division of Pediatric Endocrinology and Diabetology, University Children’s Hospital, Freiburgstrasse 15/C845, 3010, Bern, Switzerland

    Christa Flück

Authors
  1. Michael von Wolff
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  2. Petra Stute
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  3. Christa Flück
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Corresponding author

Correspondence to Michael von Wolff.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain studies with human participants or animals performed by any of the authors.

Additional information

Communicated by Beat Steinmann

Revisions received: 18 August 2016; 27 August 2016

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von Wolff, M., Stute, P. & Flück, C. Autologous transplantation of cryopreserved ovarian tissue to induce puberty—the endocrinologists’ view. Eur J Pediatr 175, 2007–2010 (2016). https://doi.org/10.1007/s00431-016-2771-1

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  • DOI: https://doi.org/10.1007/s00431-016-2771-1

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