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Hum. Reprod. Advance Access originally published online on February 18, 2008
Human Reproduction 2008 23(7):1531-1537; doi:10.1093/humrep/den032
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A series of monozygotic twins discordant for ovarian failure: ovary transplantation (cortical versus microvascular) and cryopreservation

S.J. Silber1,4, M. DeRosa1, J. Pineda1, K. Lenahan1, D. Grenia1, K. Gorman2 and R.G. Gosden3

1 Infertility Center of St. Louis, 224 South Woods Mill Road St. Louis, 63017 MO, USA 2 Paternity Testing Corporation, 300 Portland Street Columbia, 65201 MO, USA 3 Center for Reproductive Medicine and Infertility, Weill Medical College of Cornell University, 1305 York Avenue, 7th Floor, New York, 10021 NY, USA

4 Correspondence address. Tel: +1-314-576-1400; Fax: 314-576-1442; E-mail: silber{at}infertile.com

BACKGROUND: A series of monozygotic (MZ) twin pairs discordant for premature ovarian failure presented an unusual opportunity to study ovarian transplantation.

METHODS: Ten MZ twin pairs requested ovarian transplantation and eight have undergone transplantation with cryopreservation of spare tissue. Seven had a fresh cortical tissue transplant, one of whom received a second frozen–thawed transplant after the first ceased functioning at three years. One had a fresh microvascular transplant.

RESULTS: All recipients reinitiated ovulatory menstrual cycles and normal Day 3 serum FSH levels by 77–142 days. Six have already conceived naturally (one twice). Currently, two healthy babies have been delivered, and another three pregnancies are ongoing. The oldest transplant functioned for 36 months, resulting in one child and one miscarriage. She conceived again after a frozen–thawed secondary transplant. There was no apparent difference in return of ovarian function between the eight fresh ovarian grafts and the one frozen graft.

CONCLUSIONS: Ovarian transplantation appears to restore ovulatory function robustly. Successful pregnancies, including one after cryopreservation, bode well for application to fertility preservation.

Key words: cryopreservation/fertility/menopause/monozygotic twins/ovary/transplantation

Submitted on August 15, 2007; resubmitted on January 14, 2008; accepted on January 23, 2008.


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