Ovarian tissue cryopreservation for fertility preservation before hematopoietic stem cell transplantation in patients with sickle cell disease: safety, ovarian function follow-up, and results of ovarian tissue transplantation

J Assist Reprod Genet. 2024 Apr;41(4):1027-1034. doi: 10.1007/s10815-024-03054-4. Epub 2024 Feb 15.

Abstract

Purpose: To describe the experience of performing ovarian tissue cryopreservation (OTC) before hematopoietic stem cell transplantation (HSCT), among girls/women with severe sickle cell disease (SCD)(SS or S/β0-thalassemia) who are, besides the usual surgical risk, at risk of SCD-related complications during the fertility preservation procedure for improving their counseling and management.

Methods: This retrospective study included 75 patients (girls/women) with SCD who have had OTC before myeloablative conditioning regimen (MAC) for HSCT. Characteristics of patients and data on OTC, ovarian status follow-up, and results of ovarian tissue transplantation (OTT) were collected in medical records.

Results: At OTC, the median (IQR 25-75; range) age of the patients was 9.6 (6.9-14.1; 3.6-28.3) years, 56/75 were prepubertal, and no SCD or surgery-related complications occurred. The median follow-up post-HSCT was > 9 years. At the last follow-up, among prepubertal patients at HSCT, 26/56 were ≥ 15 years old and presented with a premature ovarian insufficiency (POI), except 2, including the patient who had received an OTT to induce puberty. Eight were 13-15 years old and presented for POI. The remaining 22 patients were under 13. Among the 19 patients who were menarche at HSCT, 2 died 6 months post-HSCT and we do not have ovarian function follow-up for the other 2 patients. All the remaining patients (n = 15) had POI. Five patients had OTT. All had a return of ovarian function. One patient gave birth to a healthy baby.

Conclusion: OTC is a safe fertility preservation technique and could be offered before MAC independent of the patient's age.

Keywords: Fertility preservation; Hematopoietic stem cell transplantation; Ovarian function follow-up; Ovarian tissue cryopreservation; Ovarian tissue transplantation; Sickle cell disease.

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Sickle Cell* / therapy
  • Child
  • Child, Preschool
  • Cryopreservation* / methods
  • Female
  • Fertility Preservation* / methods
  • Follow-Up Studies
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Hematopoietic Stem Cell Transplantation* / methods
  • Humans
  • Ovary* / transplantation
  • Pregnancy
  • Primary Ovarian Insufficiency*
  • Retrospective Studies
  • Transplantation Conditioning / adverse effects
  • Transplantation Conditioning / methods
  • Young Adult