Ovarian tissue cryopreservation important to offer before gonadotoxic therapy

Ovarian tissue cryopreservation important to offer before gonadotoxic therapy | Image Credit: © rh2010 - © rh2010 - stock.adobe.com.

According to a recent study published in Frontiers in Endocrinology, girls at a high risk of developing premature ovarian insufficiency (POI) after gonadotoxic therapies should be offered ovarian tissue cryopreservation (OTC) to increase the odds of fertility and endocrine restoration.

While advancements in cancer treatment have led to increased survival rates among children and adolescents, patients receiving chemotherapy and radiotherapy experience gonadal damage, often causing acute ovarian failure and sterility. This makes fertility preservation vital for pediatric and adult female patients receiving gonadotoxic treatments.

OTC followed by ovarian tissue transplantation has been proven as a viable method of preserving endocrine and reproductive functions in female patients, with OTC currently being the only feasible method in prepubertal girls. However, data on patient outcomes after OTC in pediatric patients is lacking.

To report 16 years of experience in OTC in patients aged under 18 years, investigators conducted a retrospective study of 2 French pediatric centers between January 2004 and May 2020. There were 72 pediatric patients who underwent OTC prior to highly gonadotoxic therapy.

OTC was determined by the inclusion of conditioning for autologous or allogeneic hematologic stem cell transplantation, ovariectomy, total body or pelvic irradiation, or high‐dose chemotherapy. Ovarian tissue removal included unilateral ovariectomy or bilateral partial ovariectomy at approximately one-third of the ovary.

Cryopreservation was accomplished by placing fragments of the ovarian cortex in a straw or cryotube, followed by high-security tubes with 1 mL of a freezing solution. Following equilibration, the tubes or straws were placed in a programmable freezer with a flow temperature of +4°C.

Characteristics reported included age, malignant or non-malignant disease and treatment, and histology parameters of ovarian cortex. Follow-up data included survival rate and hormonal and fertility status.

Participants were aged a mean 9.3 years at OTC, with the youngest patient aged 2 months old. Of patients, 51 were prepubertal and 21 postpubertal. Malignant diseases were reported in 70.8% of patients, with the most frequent diagnoses being acute leukemia, neuroblastoma, and hemoglobinopathies.

Individual patients had an average 17 fragments preserved. Partial bilateral ovariectomy obtained more fragments than total unilateral ovariectomy. While age correlated with the number of fragments preserved, it negatively correlated with follicular density.

Post-harvest follow-up occurred for a median 92 months. The mortality rate during follow-up was 20.8% and was highest in patients with malignant solid tumors. POI was diagnosed in 26 patients.

These results indicated efficacy from POI. Investigators recommended OTC be offered to high-risk girls and young women to minimize POI risk.

Reference

Grellet-Grün M, Delepine B, Le Van Quyen P. A 16-year bicentric retrospective analysis of ovarian tissue cryopreservation in pediatric units: indications, results, and outcome. Front Endocrinol (Lausanne). 2023;14:1158405. doi:10.3389/fendo.2023.1158405