Transplantation of Tiny Ovarian Tissue Fragments using Pipelle is Effective – Method Evaluation and Live Births

Myriam Safrai 1,2 Hila Raanani 1,2 Moran Shapira 1,2 Daniel Shai 1,2 Avi Tsur 1,2 David Stockheim 1,2 Dror Meirow 1,2
1Morris Kahn Fertility Preservation Center, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
2Sackler school of medicine, Tel Aviv University, Israel

Introduction:
Ovarian tissue cryopreservations-ovarian transplantations (OTC-OT) are established procedures in patients facing premature ovarian failure. Precedently, ovaries were cryopreserved in different dimensions, including tiny (~2mm3) fragments. While OT techniques using 25mm3 pieces are successfully practiced, tiny strips cannot be handled with laparoscopic utensils, creating the need for another efficient transplantation technique with proven results.

Methods:
Technique: The tip of a pipelle cannula was removed, several thawed ovarian fragments were loaded into the cannula. Each cannula was entered through the laparoscopic port, and the tiny pieces were pushed into the prepared pockets in the ovary/peritoneum.

Patients:
We retrospectively compared patients who underwent OT of tiny pieces via pipelle technique to a control group selected from patients who underwent transplantation of regular-sized ovarian pieces, matching the age at the time of OTC. We assessed the time to return menses, IVF outcomes (number of oocytes/fertilization/embryo transferred), and reproductive outcomes

Results:
Three patients had OT by pipelle methods; the control group included 12 patients. Pipelle procedure was short with no complications. All the endocrines and IVF parameters assessed were in the range of the control group. Patient #1 achieved live birth after 3 IVF cycles. Patient #2 had 2 spontaneous live births after 6 IVF cycles. Patient #3 has endocrine function 4 years after OT and is under IVF treatment.

Conclusion:
We report the first 3 live births after OT using pipelle techniques. These results emphasize that pipelle transplantation is feasible and establishes proof of concept demonstrating for tiny pieces making OT more accessible.