First live birth in germany after re-transplantation of cryopreserved ovarian tissue: original device for initiation of ice formation.

BACKGROUND: The problem of post-cancer infertility is of significant concern. The cryopreservation of ovarian tissue before cancer therapy with retransplantation after convalescence is the key to solving this problem. METHODS: Cryopreservation of ovarian tissue was performed in 2005 after surgical operation, post-operative low-temperature 22 hour transportation, and freezing using a special, original design block constructed for the initiation of ice formation (ice-seeding). We present the construction and function of this block. RESULTS: In 2011, it was noted that a baby was born after thawing and re-transplantation of ovarian tissue. The technical and biological aspects of initiated crystals formation in the process of cryopreservation are emphasised and discussed. CONCLUSIONS: The first live birth in Germany after re-transplantation of cryopreserved ovarian tissue was noted. This cryopreservation was performed using the protocol described here. Block for auto-seeding of principally new construction recommended.

Live birth after ovarian tissue autotransplantation following overnight transportation before cryopreservation.

OBJECTIVE: To describe the first live birth after transplantation of ovarian tissue following overnight transportation of the tissue before freezing. DESIGN: Technical note. SETTING: University department of obstetrics and gynecology. PATIENT(S): A 25-year-old cancer survivor with previous Hodgkin disease and relapse. INTERVENTION(S): The ovarian tissue was kept cool for >20 hours in a special transport medium and a special cooling device before it was cryopreserved. After premature ovarian failure due to preconditioning chemotherapy for bone marrow transplantation, the cryopreserved ovarian tissue was transplanted orthotopically. MAIN OUTCOME MEASURE(S): Resumption of ovarian function after transplantation, recovery of fertility, and pregnancy. RESULT(S): Ovarian function returned in the patient 3 months after transplantation, as shown by follicle development and estrogen production. During the fifth menstrual cycle, mild stimulation with FSH was initiated in accordance with a low-dose protocol. When ultrasonography revealed a follicle 18-20 mm in size in the ovarian graft, hCG was added and the patient had sexual intercourse at the optimal time point. On day 14 of the luteal phase, hCG concentration and vaginal echography confirmed a viable intrauterine pregnancy, which resulted in a healthy live birth. CONCLUSION(S): Overnight transportation of ovarian tissue appears to be possible in combination with appropriate transportation logistics. However, further investigations are needed before this procedure can be offered as a chance for women to preserve fertility independently of direct access to a tissue-processing bank.

Retransplantation of cryopreserved ovarian tissue: the first live birth in Germany.

BACKGROUND: Cryopreserved ovarian tissue can be retransplanted to restore fertility after radiation or chemotherapy. To date, 15 live births after retransplantation have been reported worldwide. We report the first pregnancy and the first live birth after retransplantation in Germany. CASE REPORT: A 25-year-old female patient received initial chemotherapy and radiation of the mediastinum for Hodgkin's lymphoma in 2003 and suffered a relapse two years later. Ovarian tissue was laparoscopically removed and cryopreserved, and she was then treated with high-dose chemotherapy and stem cell transplantation. She remained in remission for 5 years and she could not conceive during this time. The cryopreserved ovarian tissue was thawed and laparoscopically retransplanted into a peritoneal pouch in the ovarian fossa of the right pelvic wall. Three months later, her menopausal symptoms resolved, and she had her first spontaneous menstruation. Six months after retransplantation, after two normal menstrual cycles, low-dose follicle stimulating hormone (FSH) treatment induced the appearance of a dominant follicle in the tissue graft. Ovulation was then induced with human chorionic gonadotropin (HCG), whereupon the patient conceived naturally. After an uncomplicated pregnancy, she bore a healthy child by Caesarean section on 10 October 2011. Histological examination of biopsy specimens revealed that the ovarian tissue of the graft contained follicles in various stages of development, while the original ovaries contained only structures without any reproductive potential. CONCLUSION: This was the first live birth after retransplantation of cryopreserved ovarian tissue in Germany and also the first case with histological confirmation that the oocyte from which the patient conceived could only have come from the retransplanted tissue. In general, young women who will be undergoing chemotherapy and/or radiotherapy for cancer must be informed and counseled about the available options for fertility preservation.

Glycodelin binding to human ejaculated spermatozoa is correlated with sperm morphology.

OBJECTIVE: To investigate glycodelin (Gd) binding to the surface of sperm cells in relation to sperm morphology and seminal plasma Gd. DESIGN: Retrospective study. SETTING: University-based IVF Unit, Department of Gynecology and Obstetrics. PATIENT(S): A total of 5,749 spermatozoa from 42 patients were analyzed. INTERVENTION(S): Evaluation of sperm cell morphology according to World Health Organization criteria, measurement of Gd binding by an immunocytochemical staining method, scoring of Gd binding per spermatozoon, and assessment of Gd levels in seminal plasma Gd by ELISA. MAIN OUTCOME MEASURE(S): Glycodelin binding per sperm cell was correlated with ejaculate classes, single cell morphology, and Gd in seminal plasma. RESULT(S): Variability was observed in the scoring of sperm surface Gd binding per ejaculate and of the Gd levels (36.4-578.2 microg/mL) in human seminal plasma. Surface and seminal plasma Gd values showed no correlation in all cases. However, Gd adherence to the sperm surface depended on sperm morphology according WHO-criteria. There was reduced Gd binding to normal-shaped male gametes compared with abnormal spermatozoa. CONCLUSION(S): Glycodelin binding to human spermatozoa correlates with sperm morphology. The variability of Gd adherence suggests differences in sperm membrane properties according to the quality of the spermatozoa.