Although the first successful preservation of fertility from the freezing, thawing and grafting of ovarian tissue was reported eight years ago, the technique has remained experimental and confined to a few specialist centres. Now, with the announcement of a first pregnancy (and subsequent live birth) in Italy following the transplantation of ovarian tissue, there are indications that fertility preservation is moving into the mainstream of reproductive medicine and into a greater number of centres.
"Fertility preservation is now a key component of the management of young cancer patients," said Dr Gianluca Gennarelli from Clinica Universitaria Sant'Anna in Turin, presenting details of the Italian pregnancy at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology). "Though still a challenging procedure, the cryopreservation of ovarian cortex should still be offered to young women and girls ahead of potentially gonadotoxic cancer treatments with a high risk of ovarian failure," he said.
The Italian case described by Dr Gennarelli was remarkable not just because it is Italy's first successful pregnancy and delivery, but also because - with a gap of seven years - it represents one of the longest time intervals yet between the date of tissue freezing and the date of successful transplantation. "It demonstrates that pregnancy can be obtained by this technique even after several years of cryostorage," said Dr Gennarelli.
The case involved a 21-year-old patient scheduled for high dose chemotherapy and bone marrow transplantation. Just before treatment, in July 2003, she was referred for fertility preservation, with ovarian cortical tissue collected by laparoscopy. Bilateral biopsies of ovarian cortex were sampled (ie, from both ovaries), frozen by slow freezing and stored in liquid nitrogen. As feared, chemotherapy was followed by ovarian failure.
In March 2010, following the patient's request and investigation for fertility restoration, 32 cortical tissue fragments were thawed and sutured to prepared sites. Two months after the tissue grafting, some ovarian function returned and spontaneous follicular development was observed. Over the following months spontaneous menstrual cycles were repeatedly evident and ovulation was confirmed in at least six cycles. In July 2011, 15 months after the ovarian tissue transplantation, the patient became spontaneously pregnant, and a healthy baby was delivered in March 2012.
The birth is believed to be the 22nd in the world from this technique, and a new indication that the restoration of fertility by this technique is feasible, rapidly evolving and worthwhile for a growing number of patients. Given the increase in cancer survival, and the likelihood that many successfully treated young women and girls will live to enjoy their "reproductive" years, interest in the technique - from both patients and doctors - is sure to grow, said Dr Gennarelli.