Spontaneous twin pregnancy with live births after cryopreservation and re-implantation of ovarian tissue
© The Author(s). 2017
Received: 22 February 2017
Accepted: 2 June 2017
Published: 14 June 2017
KeywordsFertility preservation Ovarian transplantation Pregnancy, Twin Livebirth
Ovarian tissue cryopreservation (OTC) before gonadotoxic treatment and subsequent avascular auto-transplantation is a method of fertility preservation in cancer patients, with first birth reported in 2004 . This method has resulted in more than 85 livebirths worldwide [2–4], with delivery rate of 25–32% per transplanted woman [2, 3].
Menstrual bleedings occurred 21, 40, and 51 days after re-implantation. Thirty days after the surgery, TVS demonstrated corpus luteum on the left ovary, and the transplant measured 15 × 8 × 11 mm on the right side. Progesterone level was 28 nmol/l. TVS on day 112 after re-implantation demonstrated triple endometrium on 7 mm, two antral follicles on the left ovary, and one follicle on the right side. One hundred thirty-four days after re-implantation, TVS confirmed spontaneous viable dichoriotic diamniotic twin intrauterine pregnancy corresponding to pregnancy week 5 + 4. Spontaneous vaginal delivery occurred at gestational week 37 + 2 of a healthy girl and boy weighing 2085 and 2480 g, respectively. Nineteen months after transplantation, the patient has regular menstrual bleeding.
To our best knowledge, we report a first spontaneous twin pregnancy after OTC and auto-transplantation. Twin pregnancies and livebirths following OTC and IVF were published before . Estradiol production by ovarian cyst can explain normal gonadotropin level 4 months before re-implantation. Gonadotropins increased to castrated level after cyst excision (Fig. 1a). We cannot completely rule out the possibility that early bleeding pattern reflected hormonal activity of the native ovary. However, pregnancy was already reported 2 months after ovarian tissue transplantation . Regular menstrual pattern after delivery confirms graft hormonal function. Re-implantation may be performed by laparoscopy or by laparotomy [1–4]. We choose surgery by 6-cm laparotomy using surgical loops and respecting microsurgical rules, after our experience on uterus transplantation and animal experiments [6, 7]. Otherwise, this is the first auto-transplantation performed at Sahlgrenska Academy Hospital since the OTC program was introduced in 1995.
No funding was required.
MM performed the project development, surgery, and manuscript writing. MB performed the project development and surgery. CDG performed the surgery. KL performed the project development and manuscript writing. US and BS performed the laboratory work. AK performed the data collection and manuscript writing. BG, HB, and CM performed the data collection. LMA performed the data collection and manuscript writing. AT-K performed the project development and manuscript writing. All authors read and approved the final manuscript.
The authors declare that they have no conflict of interests.
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This is a case report with no identifiable data. Informed consent was not obtained.
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This is not applicable for this study.
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