895 The utility, safety and outcomes of ovarian tissue cryopreservation for gynecologic cancers: an analysis from a large fertility preservation program and systematic review of the literature

Introduction/Background

Since its first transplant success in 2000 (Oktay-Karlikaya NEJM 2000), ovarian tissue cryopreservation (OTC) has been increasingly successful and no longer considered experimental. We sought to determine the utility of OTC in gynecological cancers as the experience is limited.

Methodology

100 OTC cases in our fertility preservation program (1997–2022) and those obtained from a systematic literature review were included in the analysis.

Results

Our OTC indications included hematologic malignancies (39%), breast (15%), gynecological (12%), and other cancers (9%) and non-cancer (25%). For gynecological cancer, the median age at OTC was 29.5 years. Of those, 3 had endometrial cancer (endometroid type with stages 1A, 1B, and 3A), 2 cervical cancer (stage 2-adenocarcinoma, stage 1B-squamous), and 7 ovarian tumors (2 epithelial carcinoma, 1 teratoma, 1 yolk sac tumor, 1 dysgerminoma and 2 borderline). Of these, 1 returned for ovarian tissue transplantation (OTT), resulting in generation of 4 embryos. The patient is awaiting embryo transfer to a gestational carrier. On systematic review, OTC and OTT rates for gynecological cancers were 7.1% and 13.08%, respectively (Figure-1A-B). Of all OTC, 178 were for gynecological cancers with OTT return rate of 5.6% (Figure-1C). The median age at OTC was 31 years and graft longevity was 32 months. Following ART, cumulative delivery rate was 40%/recipient (two deliveries in granulosa cell tumor and ovarian mucinous cancer, two miscarriages in ovarian borderline tumor and endometrial sarcoma, and no oocytes retrieved in one with cervical cancer). No cancer recurrence was reported after OTT in graft sites. In one case with granulosa cell tumor, diaphragmatic and pelvic brim metastases were resected along with graft during the C-section; the patient remained in complete remission.

Conclusion

Though the return rate is low, OTC+OTT appears to be generally safe in gynecological cancer, resulting in live-births. However, OTC+OTT may carry a risk of metastasis in granulosa cell tumors.

Disclosures

No disclosures.