Limited Value of Ovarian Function Markers following Orthotopic Transplantation of Ovarian Tissue after Gonadotoxic Treatment

• Published in: The journal of clinical endocrinology and metabolism 2011-04, Vol.96 (4), p.1136-1144
• Main Authors: Janse, Femi, Donnez, Jacques, Anckaert, Ellen, de Jong, Frank H, Fauser, Bart C. J. M, Dolmans, Marie-Madeleine
• Format: Article
• Language: English
• Subjects: Adult; Anti-Mullerian Hormone - analysis; Anti-Mullerian Hormone - blood; Antineoplastic Agents - adverse effects; Biological and medical sciences; Biomarkers - analysis; Cryopreservation; Endocrinopathies; Estradiol - analysis; Estradiol - blood; Feeding. Feeding behavior; Female; Follicle Stimulating Hormone - analysis; Follicle Stimulating Hormone - blood; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Infertility, Female - blood; Infertility, Female - diagnosis; Infertility, Female - prevention & control; Inhibins - analysis; Inhibins - blood; Medical sciences; Ovary - physiology; Ovary - transplantation; Predictive Value of Tests; Pregnancy; Primary Ovarian Insufficiency - chemically induced; Primary Ovarian Insufficiency - physiopathology; Primary Ovarian Insufficiency - rehabilitation; Primary Ovarian Insufficiency - therapy; Transplantation, Heterotopic; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2010-2188

Evaluation of markers of ovarian function and reserve in women following orthotopic ovarian transplantation indicates a minor role for anti-Müllerian hormone and inhibin B. Context: In young women, some treatments for cancer or other conditions (such as sickle cell anemia) may give rise to primary ovarian insufficiency. Ovarian transplantation is one of the available options for fertility preservation, with highly variable pregnancy rates. Objective: The objective of the study was to investigate markers of ovarian reserve and ovarian function in women up to 7 yr after orthotopic ovarian transplantation. Secondary objectives were to assess the relationship between markers of ovarian reserve and pregnancy rate along with the duration of ovarian function. Design: This was a prospective cohort study in 10 women, with a mean follow-up of 2.5 yr. Setting: The study was conducted at a university hospital in Brussels, Belgium. Patients: Patients included 10 women who were about to receive or had previously received gonadotoxic treatment. In seven women cryopreservation of ovarian tissue was performed before starting treatment. Subsequently autografts were orthotopically transplanted in these women. Three women, who had already developed primary ovarian insufficiency due to treatment, underwent orthotopic transplantation of ovarian allograft tissue originating from their human leukocyte antigen-compatible sisters. Main Outcome Measures: Serum concentrations of FSH, LH, estradiol, inhibin B, and anti-Müllerian hormone (AMH) were measured. Results: On average, first menses took place after 4.7 months. Duration of graft functioning varied from 2 to more than 60 months. FSH concentrations remained elevated, whereas estradiol levels normalized and AMH was low to undetectable. Inhibin B varied among women and was not associated with the duration of ovarian function (hazard ratio 0.966, 95% confidence interval 0.881–1.059). Two spontaneous pregnancies occurred. Endocrine characteristics were not significantly different in these women. Conclusions: Low AMH and inhibin B concentrations may suggest decreased ovarian reserve in women after ovarian transplantation. AMH and inhibin B levels may not be associated with the duration of ovarian graft function or probability to achieve a pregnancy.