Volume 10, Issue 3 (2025)
SJMR 2025, 10(3): 159-165 |
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Saremi A, Nateghi M R. A Successful Case of Ovarian Tissue Cryopreservation and Autologous Transplantation in a Patient with Premature Ovarian Insufficiency: Restoration of Ovarian Function and Fertility. SJMR 2025; 10 (3) : 7
URL: http://saremjrm.com/article-1-361-en.html
URL: http://saremjrm.com/article-1-361-en.html
1- - Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
Abstract: (109 Views)
Introduction: Ovarian tissue cryopreservation and transplantation represent one of the most advanced and promising approaches for fertility preservation and restoration in women with premature ovarian insufficiency (POI). This technique is particularly valuable for patients who cannot undergo ovarian stimulation for oocyte retrieval or those with severely diminished ovarian reserve. Recent studies have demonstrated that autologous ovarian tissue transplantation, whether orthotopic (at the natural ovarian site) or heterotopic (at alternative sites such as the subcutaneous tissue of the arm or abdominal wall), can successfully restore endocrine activity, induce follicular growth, and even result in natural conception. The present report describes a successful case of ovarian tissue cryopreservation and autologous transplantation in a patient with POI, performed at Sarem Subspecialty Hospital, Tehran, Iran.
Case Presentation: A 40-year-old woman with one child from her first marriage and secondary infertility from her second marriage presented with premature ovarian insufficiency. Hormonal evaluations revealed elevated FSH levels (rising from 13.8 to 28.4 mIU/mL) and markedly decreased AMH (from 0.1 to 0.03 ng/mL), consistent with severe ovarian failure. Ovarian tissue cryopreservation was performed in 2016. In 2018, one thawed ovarian tissue fragment was transplanted heterotopically into the right upper arm and another orthotopically into the right ovary. Follow-up ultrasound examinations demonstrated follicular development at both sites, and AMH levels increased from 0.08 to 0.8 ng/mL, indicating partial restoration of ovarian function. The patient subsequently underwent several assisted reproductive cycles (ICSI and FET), culminating in a successful twin pregnancy and delivery of healthy infants. After childbirth, she experienced spontaneous regular menstruation for several months, followed by withdrawal bleeding with dydrogesterone. In 2025, due to rising FSH levels, a second heterotopic transplantation into the right arm adipose tissue was performed.
Conclusion: This case demonstrates the clinical success of ovarian tissue cryopreservation and autologous transplantation in restoring ovarian endocrine function and achieving pregnancy in a patient with POI. The observed increase in hormonal markers and follicular growth confirms the viability of grafted follicles and partial ovarian recovery. Moreover, the sustained endocrine function for several years and feasibility of repeat transplantation highlight the potential of this technique as a valuable strategy for managing infertility related to premature ovarian insufficiency.
Case Presentation: A 40-year-old woman with one child from her first marriage and secondary infertility from her second marriage presented with premature ovarian insufficiency. Hormonal evaluations revealed elevated FSH levels (rising from 13.8 to 28.4 mIU/mL) and markedly decreased AMH (from 0.1 to 0.03 ng/mL), consistent with severe ovarian failure. Ovarian tissue cryopreservation was performed in 2016. In 2018, one thawed ovarian tissue fragment was transplanted heterotopically into the right upper arm and another orthotopically into the right ovary. Follow-up ultrasound examinations demonstrated follicular development at both sites, and AMH levels increased from 0.08 to 0.8 ng/mL, indicating partial restoration of ovarian function. The patient subsequently underwent several assisted reproductive cycles (ICSI and FET), culminating in a successful twin pregnancy and delivery of healthy infants. After childbirth, she experienced spontaneous regular menstruation for several months, followed by withdrawal bleeding with dydrogesterone. In 2025, due to rising FSH levels, a second heterotopic transplantation into the right arm adipose tissue was performed.
Conclusion: This case demonstrates the clinical success of ovarian tissue cryopreservation and autologous transplantation in restoring ovarian endocrine function and achieving pregnancy in a patient with POI. The observed increase in hormonal markers and follicular growth confirms the viability of grafted follicles and partial ovarian recovery. Moreover, the sustained endocrine function for several years and feasibility of repeat transplantation highlight the potential of this technique as a valuable strategy for managing infertility related to premature ovarian insufficiency.
Article number: 7
Keywords: Premature Ovarian Insufficiency, Ovarian Tissue Cryopreservation, Autologous Ovarian Transplantation, Heterotopic Graft, Orthotopic Graft.
Article Type: Case Report |
Subject:
Women Diseases
Received: 2025/10/7 | Accepted: 2025/10/20 | Published: 2025/10/26
Received: 2025/10/7 | Accepted: 2025/10/20 | Published: 2025/10/26
References
1. 1 Rajabi, Z., Aliakbari, F. & Yazdekhasti, H. Female Fertility Preservation, Clinical and Experimental Options. Journal of reproduction & infertility 19, 125-132 (2018).
2. 2 Emrich, N. L. A., Einenkel, R., Färber, C. M., Schallmoser, A. & Sänger, N. Ovarian tissue cryopreservation for fertility preservation: a two-decade single-center experience with 451 children and adolescents. Reproductive biology and endocrinology : RB&E 23, 51, doi:10.1186/s12958-025-01388-x (2025). [DOI:10.1186/s12958-025-01388-x] [PMID] []
3. 3 Rowling, H. R., van der Westerlaken, L. A. J. & Lashley, E. E. L. O. To improve outcome after ovarian tissue cryopreservation and transplantation: Clinical approach based on a case series and literature review. Journal of Obstetrics and Gynaecology Research 51, e70080, doi:
https://doi.org/10.1111/jog.70080 [DOI:10.1111/jog.70080 (2025).] [PMID]
4. 4 Karimizadeh, Z., Saltanatpour, Z., Tarafdari, A., Rezaeinejad, M. & Hamidieh, A. A. Ovarian tissue cryopreservation: a narrative review on cryopreservation and transplantation techniques, and the clinical outcomes. Therapeutic advances in reproductive health 19, 26334941251340517, doi:10.1177/26334941251340517 (2025). [DOI:10.1177/26334941251340517] [PMID] []
5. 5 Kristensen, S. G. & Andersen, C. Y. Cryopreservation of Ovarian Tissue: Opportunities Beyond Fertility Preservation and a Positive View Into the Future. Frontiers in endocrinology 9, 347, doi:10.3389/fendo.2018.00347 (2018). [DOI:10.3389/fendo.2018.00347] [PMID] []
6. 6 Silber, S. J. et al. In-vitro maturation and transplantation of cryopreserved ovary tissue: understanding ovarian longevity. Reproductive BioMedicine Online 44, 504-514, doi:
https://doi.org/10.1016/j.rbmo.2021.11.015 [DOI:10.1016/j.rbmo.2021.11.015 (2022).] [PMID]
7. 7 Fathi, R., Rezazadeh Valojerdi, M., Salehnia, M., Ebrahimi, B. & SalmanYazdi, R. Ovarian Tissue Transplantation: Advantages, Disadvantages and Upcoming Challenges (A Review Article). Journal of Mazandaran University of Medical Sciences 24, 253-265 (2014).
8. 8 Demeestere, I., Simon, P., Emiliani, S., Delbaere, A. & Englert, Y. Orthotopic and heterotopic ovarian tissue transplantation. Human reproduction update 15, 649-665, doi:10.1093/humupd/dmp021 (2009). [DOI:10.1093/humupd/dmp021] [PMID] []
9. 9 Grynberg, M. et al. Ovarian tissue and follicle transplantation as an option for fertility preservation. Fertility and Sterility 97, 1260-1268, doi:
https://doi.org/10.1016/j.fertnstert.2012.04.042 [DOI:10.1016/j.fertnstert.2012.04.042 (2012).] [PMID]
10. 10 Benetti-Pinto, C. L. et al. Premature ovarian insufficiency: A hormonal treatment approach. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia 42, 511-518, doi:10.1055/s-0040-1716929 (2020). [DOI:10.1055/s-0040-1716929] [PMID] []
11. 11 Sharata, E. E. et al. Decoding premature ovarian insufficiency: A full spectrum review from epidemiology to management with emphasis on cyclophosphamide-evoked ovarian injury. Food and Chemical Toxicology 205, 115719, doi:
https://doi.org/10.1016/j.fct.2025.115719 [DOI:10.1016/j.fct.2025.115719 (2025).] [PMID]
12. 12 Ishizuka, B. Current Understanding of the Etiology, Symptomatology, and Treatment Options in Premature Ovarian Insufficiency (POI). Frontiers in endocrinology 12, 626924, doi:10.3389/fendo.2021.626924 (2021). [DOI:10.3389/fendo.2021.626924] [PMID] []
13. 13 Kim, H. K. & Kim, T. J. Current Status and Future Prospects of Stem Cell Therapy for Infertile Patients with Premature Ovarian Insufficiency. Biomolecules 14, doi:10.3390/biom14020242 (2024). [DOI:10.3390/biom14020242] [PMID] []
14. 14 Lotz, L., Dittrich, R., Hoffmann, I. & Beckmann, M. W. Ovarian Tissue Transplantation: Experience From Germany and Worldwide Efficacy. Clinical medicine insights. Reproductive health 13, 1179558119867357, doi:10.1177/1179558119867357 (2019). [DOI:10.1177/1179558119867357] [PMID] []
15. 15 Sonigo, C., Beau, I., Binart, N. & Grynberg, M. Anti-Müllerian Hormone in Fertility Preservation: Clinical and Therapeutic Applications. Clinical medicine insights. Reproductive health 13, 1179558119854755, doi:10.1177/1179558119854755 (2019). [DOI:10.1177/1179558119854755] [PMID] []
16. 16 Zhai, J. et al. In Vitro Activation of Follicles and Fresh Tissue Auto-transplantation in Primary Ovarian Insufficiency Patients. The Journal of clinical endocrinology and metabolism 101, 4405-4412, doi:10.1210/jc.2016-1589 (2016). [DOI:10.1210/jc.2016-1589] [PMID] []
17. 17 Huang, C. et al. Transplantation of UC-MSCs in ovary improves ovarian function and intermediate outcomes in IVF/ICSI cycles of POI patients: a clinical cohort study. Stem cell research & therapy 16, 552, doi:10.1186/s13287-025-04680-0 (2025). [DOI:10.1186/s13287-025-04680-0] [PMID] []
18. 18 Shafti, V. & Azarboo, A. Ovarian Tissue Cryopreservation for An Extended Reproductive Lifespan: A Natural Means to Delay Menopause. Sarem Journal of Medical Research 10, 95-102, doi:DOI: 1052547/sjrm.10.2.7 (2025).
19. 19 Saremi, A. New Horizons in Ovarian Tissue Cryopreservation: From Clinical Evidence to Research Perspectives. Sarem Journal of Medical Research 10, 109-112, doi:DOI: 1052547/sjrm.10.3.1 (2025).
20. 20 Mardešić, T., Jelínková, L. & Melicharová, L. [Successful ovarian tissue transplantation in woman with premature ovarian failure after gonadotoxic treatment]. Ceska gynekologie 82, 38-41 (2017).
21. 21 Radwan, P., Abramik, A., Wilczyński, J. & Radwan, M. Successful autotransplantation of cryopreserved ovarian tissue with recovery of the ovarian function. Ginekologia polska 87, 235-240, doi:10.17772/gp/61981 (2016). [DOI:10.17772/gp/61981] [PMID]
22. 22 Schmidt, K. T. et al. Autotransplantation of cryopreserved ovarian tissue in 12 women with chemotherapy-induced premature ovarian failure: the Danish experience. Fertil Steril 95, 695-701, doi:10.1016/j.fertnstert.2010.07.1080 (2011). [DOI:10.1016/j.fertnstert.2010.07.1080] [PMID]
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