Restoration of Ovarian Function After Orthotopic Ovarian Autotransplant and Follow-Up: A Case Report

Abstract

A 40-year-old married nulliparous female diagnosed with breast cancer was referred for fertility preservation before initiation of chemotherapy. Various options were discussed and she decided for ovarian tissue cryopreservation to avoid delay in treatment for cancer. She underwent laparoscopic left oophorectomy and the retrieved ovarian cortex was cryopreserved in liquid nitrogen. Two months after initiation of chemotherapy, her menses stopped and she started experiencing hot flushes leading to a diagnosis of premature menopause based on her hormone levels. Two years later after being certified free of malignancy, she underwent orthotopic transplant of the cryopreserved ovarian tissue into the other ovary and ovarian fossa. She resumed menstruation 3 months later and her hormone analysis showed a significant drop in follicle-stimulating hormone levels and luteinizing hormone levels and rise in estrogen levels. At this point of time, she lost interest in fertility and declined in vitro fertilization. On regular follow-up to assess her ovarian function, she reported regular monthly menses for 2 years which then started becoming irregular and less frequent. During her recent review 4 years after the transplant, her menses is less frequent once in 2 - 3 months with light flow but free of menopausal symptoms. Ovarian cryopreservation and autotransplant is usually done to restore fertility in women undergoing gonadotoxic treatment. This case shows that this procedure can also be considered for women who wish to restore hormonal function thereby alleviating menopausal symptoms and improving bone and cardiovascular health even though such benefits are yet to be proven scientifically. Careful selection of cases and adequate counselling regarding the benefits, risks, cost of the procedure, uncertainty of duration of ovarian function and multidisciplinary approach are important to optimize outcome in such patients.




J Med Cases. 2017;8(1):14-16
doi: https://doi.org/10.14740/jmc2701w