Ovarian cryopreservation before chemotherapy with micro-organ ovarian transplantation yields high pregnancy rates - Israeli Fertility Association Conference-Ayala 2017, May 8-9, 2017

Ariel Revel ^1,6 Foad Azem ² Jennia Michaeli ⁴ Assaf Ben Meir ⁶ Talya Mordechai ⁶ Dalit Ben Yossef ^2,3 Eduardo Mitrani ⁵

¹Reproductive Medicine, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University
²Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center
³Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University
⁴Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem
⁵Cell and Developmental Biology, Institute of Life Sciences, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram
⁶Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School

Introduction: For children, adolescents and young women often the only method of fertility preservation is based on ovarian cryopreservation. Ovarian transplantation, performed years later following ‘iatrogenic ovarian insufficiency’ (IOIN) was recently included in the Israeli health basket. In order to avoid post transplantation ischemia we have developed Ovarian Micro-Organ (OMO) transplantation. The term MO has been coined in the past to small organ fragments that retain the basic organ functional structure while being small enough to allow diffusion of nutrients and gases to all cells within it. Essentially, those fragments constitute a “whole” organ but of microscopic thickness.

Aim: To study fertility results of OMO transplantation.

Materials & Methods: Participants were 9 IOIN patients who we previously cryopreserved ovarian cortex. Prior to ovarian transplantation we evaluated ovarian cortex for minimal residual disease. OMOs were prepared from frozen- thawed human ovarian cortex slivers and were auto-transplanted into the broad ligament where the ovary was removed. Pregnancies following ovulation induction and in vitro fertilization (IVF) were documented.

Results: Of nine patients who underwent OMO transplantations, eight pregnancies and six deliveries (1 is ongoing pregnancy) were obtained. One patient underwent transplantation twice and conceived after each transplant. All patients, who underwent OMO transplantation of ovarian tissue which has not been exposed to any chemotherapy prior to cryopreservation, conceived.

Conclusion: Transplanting OMO yields a very high pregnancy rate when the patient was not previously exposed to chemotherapy before ovarian removal. The presentation will summarize the up-to-date of ovarian transplantation in Israel and worldwide.