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Ovarian Tissue Cryopreservation and Transplantation: Scientific and Clinical Implications

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Female and Male Fertility Preservation

Abstract

After fresh or frozen ovary transplantation, FSH levels return to normal, and menstrual cycles resume by 150 days, coincident with anti-Müllerian hormone rising to higher than normal levels. AMH then returns to well below normal levels by 240 days, remaining as such for many years with nonetheless normal ovulation and fertility. To date, 27 babies have been born in our program from 11 fresh and 13 cryopreserved ovary transplant recipients with a live baby rate of over 70% (11 babies from fresh and 16 from frozen). Globally, over 180 live births have been reported for both fresh and frozen ovary transplants with a 30–71% live birth rate. Given the rapid rise of AMH after the fall of FSH, with a subsequent AMH decrease with long-term retention of ovarian function, it is tempting to speculate the existence of a shared mechanism controlling primordial follicle recruitment, fetal oocyte meiotic arrest, and recruitment in the adult ovary. With the massive recruitment of primordial follicles observed after human ovarian cortical tissue transplantation, which subsides later to an extremely low recruitment rate, we will discuss how this phenomenon suggests a unifying theory implicating ovarian cortical tissue rigidity in the regulation of both fetal oocyte arrest and recruitment of follicles in the adult ovary. Follicle loss after ovarian cortex transplantation is not due to ischemic apoptosis, but rather from a “burst” of primordial follicle recruitment because of reduced cortical tissue pressure. In vivo, primordial follicles are normally resistant to development or activation in order to prevent oocyte depletion. The dense fibrous ovarian cortex, by inducing nuclear rotation, arrests the further continuation of meiosis and also prevents a sudden depletion of all resting follicles in the adult ovary. Intrinsic tissue pressure is released after cortical tissue transplantation, temporarily resulting in a rapid follicle depletion. These results are consistent with the observation that once the ovarian reserve is reduced in the graft, the rate of recruitment diminishes and the ovarian tissue exhibits a relatively long duration of function.

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  1. Infertility Centre of St. Louis, St. Luke’s Hospital, St. Louis, MO, USA

    Sherman Silber & Sierra Goldsmith

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  1. Sherman Silber
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  2. Sierra Goldsmith
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  1. Reproductive Medicine and Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France

    Michael Grynberg

  2. Division of Reproductive Endocrinology and Infertility-Department Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, FL, USA

    Pasquale Patrizio

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Silber, S., Goldsmith, S. (2022). Ovarian Tissue Cryopreservation and Transplantation: Scientific and Clinical Implications. In: Grynberg, M., Patrizio, P. (eds) Female and Male Fertility Preservation. Springer, Cham. https://doi.org/10.1007/978-3-030-47767-7_11

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