Orthotopic reimplantation of cryopreserved ovarian cortical strips after high-dose chemotherapy for Hodgkin's lymphoma

Background Infertility is a common late effect of chemotherapy and radiothe rapy, and has a substantial effect on the quality of life for young survivo rs of cancer. For men, semen cryopreservation is a simple way of preserving reproductive potential but for women, storage of mature eggs rarely proves successful, and the alternative-immediate in vitro fertilisation with cryo preservation of embryos-is not always appropriate. Reimplantation of cryopr eserved ovarian tissue has been shown to restore natural fertility in anima ls. We applied this technique in a woman who had received sterilising chemo therapy for lymphoma. Methods A 36-year-old woman underwent a right oophorectomy with cryopreserv ation of ovarian cortical strips before receiving high-dose CBV chemotherap y for a third recurrence of Hodgkin's lymphoma. 19 months later, when serum sex steroid analysis confimed a postmenopausal state, two ovarian cortical strips were thawed and reimplanted-one onto the left ovary and another at the site of the right ovary. Findings 7 months after reimplantation of ovarian cortical strips, the pati ent reported resolution of hot flashes and, for the first time, oestradiol was detected in the serum. This finding was associated with a decrease in t he concentrations of follicle-stimulating hormone and luteinising hormone, and ultrasonography revealed a 10 mm thick endometrium, a poorly visualised left ovary, and a 2 cm diameter follicular structure to the right of the m idline, The patient had one menstrual period, but by 9 months after the imp lantation, her sex steroid concentrations had returned to those seen with o varian failure. Interpretation Orthotopic reimplantation of frozen/thawed ovarian cortical strips is a well tolerated technique for restoring ovarian function in wome n treated with sterilising chemotherapy for cancer.