Evaluation of Follicle Parameters and Reproductive Outcomes Following Ovarian Tissue Transplant in Women Exposed to Chemotherapy Treatments

Introduction
Storing ovarian tissue (OTCP) prior to chemotherapy is an effective method to preserve fertility in cancer patients. Although OTCP post recent exposure to chemotherapy has been reported, efficacy and follicle parameters have not been fully explored.

Aim
To investigate follicle density, quality and to evaluate reproductive outcome in patients exposed to chemotherapy prior to OTCP.

Methods
1. Two groups of cancer patients who underwent transplantation of ovarian tissue– exposed vs. unexposed to chemotherapy prior to OTCP. IVF performance and reproductive outcome were evaluated. 2. Histopathologic examination of ovarian tissues exposed, unexposed to chemotherapy prior to OTCP. Follicle counts, morphology and functionality parameters were used.

Results
1. 28 patients (14-39y) who underwent transplantation. 12 exposed to chemotherapy (7 alkylating agents) prior to tissue harvesting. 7/12 of exposed and 12/16 unexposed underwent IVF cycles. The average of oocytes retrieved per cycle was1.3 in chemotherapy group (average 6.7 cycles per patient) and 2.7 in unexposed (average 2.6). Fertilization rate among exposed women was 58% and for unexposed 37%. Reproductive outcome in exposed patient was 18 pregnancies, 8 spontaneous,10 live birth, 7 abortions and one ongoing pregnancy and for unexposed women 6 pregnancies all IVF, 3 live birth,4 abortions. 2. 60 ovarian samples were evaluated, 20 exposed to alkylating agents 40 control (15-39y) primordial follicle count was significant lower in the group exposed to alkylating agents however follicles morphology and functionality parameters were unaffected.

Conclusion
Although lower primordial follicle count was documented in tissue exposed to alkylating agents, follicle quality and reproductive performance were encouraging. When clinically indicated, OTCP can be offered after chemotherapy exposure, with excellent reproductive outcome.