Indications for Ovarian Tissue Cryopreservation in Children Suffering from Non-iatrogenic Primary Ovarian Insufficiency
2Sackler School of Medicine, Tel Aviv University, ישראל
3The Morris Kahn Fertility Preservation Center, Department of Obstetrics and Gynecology, Sheba Medical Center, Sheba Medical Center, ישראל
4Institute of Obstetrics and Gynecological Imaging and Fetal therapy, Department of Obstetrics and Gynecology, Sheba Medical Center, ישראל
5Department of Pediatric Surgery, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, ישראל
Objectives: To establish criteria for ovarian tissue cryopreservation (OTCP) in girls and adolescents suffering from non-iatrogenic premature ovarian insufficiency (POI).
Methods: This was a retrospective analysis of patients who were referred for fertility preservation counseling at a single tertiary hospital for non-iatrogenic POI. Patients who were 18 years or younger were included. Exclusion criterion was 46XY gonadal dysgenesis. Three parameters were evaluated: serum level of Anti-Müllerian hormone, serum level of Follicle-stimulating hormone and ovarian antral follicle count by trans-abdominal ultrasound. If ovarian reserve was diminished and at least one parameter indicated follicular activity, OTCP was proposed.
Results: Between August 2010 and January 2020, 39 patients were referred for fertility preservation counseling and 37 were included in the study (28 diagnosed with Turner syndrome, 6 with POI of unknown etiology, 3 with Galactosemia and one with Blepharophimosis, ptosis, and epicanthus inversus syndrome). One or more positive parameter suggesting ovarian activity, were found in 22 patients. Of them, 14 underwent OTCP and 2 underwent oocyte cryopreservation. OTCP was denied in two cases. Four patients had normal ovarian function and follow-up was recommended. Primordial follicles were found in 11 out of 14 patients who underwent OTCP (79%) and in all patients with two or three positive parameters (100%).
Conclusion: This study shows that when OTCP is performed in patients with one or more positive parameter of ovarian activity, the positive predictive value for the detection of primordial follicles achieves 79%. By incorporating these criteria for performing OTCP unnecessary procedures can be avoided.