Gynecology and Physiopathology of Human Reproduction Unit, Sant’Orsola-Malpighi Hospital, University of Bologna, Italy

Cryopreservation of ovarian tissue: experience of the Policlinico S.Orsola-Malpighi of Bologna The Gynecology and Physiopathology Unit of Human Reproduction of the S. Orsola-Malpighi Polyclinic, equipped with a Cryobank dedicated to the cryopreservation of ovarian tissue, is the structure with the widest nationwide case history. Since 2002, 859 patients, of which 663 adults and 196 pediatrics, cryopreserved ovarian tissue at the Operative Unit. At the Bologna Center, 25 reimplants were performed in 18 patients, obtaining the resumption of ovarian function in 90% of cases (data updated to September 2019). Worthy of note are the results obtained in 3 patients who underwent re-implantation of cryopreserved ovarian tissue. Patient 1: At the age of 29, before undergoing chemo / radiotherapy treatments for the treatment of a Hodgkin's lymphoma, the patient cryopreserved part of her ovarian tissue. Nine years later the patient experienced early ovarian failure with severe menopausal symptoms. Since the patient was interested in recovering only the steroidogenic function, a heterotopic reimplantation of ovarian tissue was performed 11 years after explantation. After 4 months from the replanting, the resumption of ovarian function was obtained, which was maintained for 3 years. The great improvement in the quality of life has prompted the patient to request a second reimplant, 15 years after cryopreservation. The endocrine function is still active (Fabbri R. et al., Successful achievement after heterotopic transplantations of long-term stored ovarian tissue in Hodgkin's lymphoma survivor. Gynecol Endocrinol. 2019). The clinical case of this patient has demonstrated for the first time in the world that the cryopreserved ovarian tissue maintains the morpho-functional characteristics after a long period of storage and is able to survive and reactivate after thawing and replanting. Patient 2: At the age of 29, before undergoing chemo / radiotherapy treatments and following bone marrow transplantation for the treatment of non-Hodgkin's lymphoma, the patient chose to cryopreserve part of her ovarian tissue. After 5 years of post-therapy follow-up, the patient required re-implantation of cryopreserved ovarian tissue. A few months after reimplantation, the ovarian function was reactivated with the subsequent establishment of a spontaneous pregnancy, which was completed without complications. The patient had a spontaneous birth which led to the birth of a child over 3 kg. The mother and child are in excellent health (Fabbri R. et al., First Italian birth after cryopreserved ovarian tissue transplantation in a patient affected by non-Hodgkin's lymphoma. Int J Hematol Oncol. 2018). Patient 3: At the age of 21, the patient, suffering from Hodgkin's lymphoma, cryopreserved part of her ovarian tissue before undergoing chemo / radiotherapy treatments and subsequent bone marrow transplantation. Upon remission of the disease, after 5 years of post-therapy follow-up, the patient required re-implantation of cryopreserved ovarian tissue. A few months after replanting, the ovarian function was reactivated but due to male infertility, the patient underwent ovarian stimulation. Following in vitro fertilization program an embryo was transferred to the uterus. The patient had a spontaneous birth which led to the birth of a child of 2.9 kg. The mother and child are in excellent health.