ESPE Abstracts

Introduction: In youth, primary ovarian insufficiency (POI) is due to genetic, autoimmune, iatrogenic, and idiopathic etiologies. When POI is diagnosed early with evidence of an ovarian reserve, fertility preservation can be offered. When the girl is premenarchal, the preferred fertility preservation method is ovarian tissue cryopreservation (OTC) containing primordial follicles. In the past, when OTC was performed in an unselected group of children and adolescents with Turner syndrome, only 25% had follicles in ovarian tissue.

Aims: To evaluate the yield of ovarian reserve parameters as predictors of OTC outcomes in girls suffering from non-iatrogenic POI, to avoid unnecessary invasive procedures.

Methods: We retrospectively assessed the ovarian reserve parameters of girls ≤ 18 years with non-iatrogenic POI who were referred for fertility preservation counseling in one tertiary center during the years 2010-2020. OTC was recommended if at least one positive parameter suggesting ovarian activity was present. A positive parameter was defined as anti-Mullerian hormone (AMH) > 0.16ng/ml, follicle-stimulating hormone (FSH) ≤ 20mIU/ml, or detection of ≥ 1 antral follicle by transabdominal sonography. Patients with 46XY gonadal dysgenesis were excluded.

Results: The cohort included 37 patients (27 Turner syndrome, 6 idiopathic POI, 3 Galactosemia, and one Blepharophimosis, Ptosis, and Epicanthus Invs syndrome). Sixteen patients underwent OTC, at a mean age of 14.2±3.1 years. Among the group who underwent OTC, compared to the group who did not have OTC, FSH was lower (29.0±31.7 vs. 53.4±52.6 mIU/ml, P=0.05), and the proportion of measurable AMH was higher (50% vs. 15%, P=0.03). The proportion of Turner patients was 1.5-fold lower among the patients who underwent OTC compared to those who did not have OTC (56% vs. 88%, P=0.02). Among the group who underwent OTC, follicles were detected among 79% of the patients, and in all patients (100%) who had 2 or 3 positive parameters. The median number of follicles was 2.5 (range 0-75) in patients who had ≥1 positive parameter, and 22.5 (range 13-64) in patients with 2-3 positive parameters.

Conclusion: This study shows that if OTC 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 these criteria will improve the success rate of OTC as a fertility preservation procedure in these patients and minimize the risk of harvesting ovarian tissue with a low number of follicles.