Can ovarian reserve parameters predict outcome of ovarian tissue cryopreservation (OTCP) in patients ≤ 18 years with non-iatrogenic premature ovarian insufficiency (POI)?
A retrospective cohort analysis carried out in a single tertiary hospital between August 2010 and January 2020. 37 patients ≤ 18 years with non-iatrogenic POI (27 with Turner syndrome, six with POI of unknown etiology, three with Galactosemia and one with Blepharophimosis-Ptosis-Epicanthus-inversus syndrome) were included. Three parameters were used to evaluate ovarian reserve: Anti-Müllerian hormone (AMH), Follicle-stimulating hormone (FSH) and trans-abdominal antral follicle count. Fertility preservation (most commonly OTCP) was offered if ovarian reserve was diminished and ≥1 parameter was positive. Follicles were counted in ovarian samples obtained at the time of OTCP.
Ovarian reserve was diminished in 34 patients and 19 of them had ≥1 positive parameter. Fourteen (11 ≥12 years and three <12) underwent OTCP, one (14 years old) underwent controlled ovarian hyper-stimulation and oocyte cryopreservation and four declined fertility preservation. Follicles were detected in 11 of 14 patients who underwent OTCP (79%), and in all those (100%) who had 2 or 3 positive parameters. The median number of follicles was 27 (range 5-64) and 48 (range 21-75) in patients ≥12 years and those <12 respectively.
This study shows that if OTCP is performed in patients with ≥1 positive parameter of ovarian activity, a 79% positive predictive value is achieved for the detection of follicles. The incorporation of this criterion for OTCP will minimize the risk of harvesting ovarian tissue with a low number of follicles.
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Michal Zajicek is the head of Gynecological Ultrasound service at the Institute of Obstetrics and Gynecological Imaging, Sheba Medical Center, Israel. Her research focuses on gynecological ultrasound. Special interest in endometriosis, fertility work-up, hydro-sonography and hystero-salpingo-sonography, Mülerian anomalies and gynecological malignancies.
Accepted: March 6, 2023
Received in revised form: February 10, 2023
Received: October 29, 2022
Publication stageIn Press Journal Pre-Proof
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