ESPE Abstracts

Background: A reduced reproductive lifespan is one of the most significant implications for girls with Turner syndrome (TS) and is due to an accelerated loss of ovarian insufficiency. Lately, there has been a surge in scientific research aimed at whether ovarian tissue cryopreservation (OTC) is a viable option for fertility preservation in girls with TS. This required a unilateral ovariectomy for girls with TS who may already have a poor ovarian reserve.

Study question: What is the impact of unilateral ovariectomy on the ovarian function of the remaining ovary in girls with TS undergoing OTC?

Methods: A prospective descriptive study of 28 girls with TS (aged 5-19 years) who underwent OTC and had follicles in the ovarian tissue. Pubertal development and levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), Oestradiol, Anti-Mullerian hormone (AMH) and inhibin B were monitored up to three years after OTC. Main results and role of chance: Of the 28 girls, 1 girl had 45, X-karyotype, 21 had mosaic-karyotype with 46,XX-cell line and 6 had other karyotypes (45,X/47,XXX or structural aberration of the X-chromosome). Puberty was induced in 1/28 girls and inhibited in 1/28 girls prior to OTC. Of the 13 prepubertal girls at OTC, 7/13 girls were still prepubertal at the end of the follow-up. Of the other 6 prepubertal girls, 4/6 had experienced spontaneous thelarche and 2/6 spontaneous menarche. In 6/6 girls with spontaneous thelarche before OTC, a spontaneous menarche occurred during the follow-up period. Of the 7 girls with menarche prior to OTC, 5/7 continued having regular menstrual bleeding. Of the 28 girls, 5 needed hormone suppletion (1 because of induction of puberty and 4 because of signs of ovarian insufficiency). Girls who experienced ovarian insufficiency had low or undetectable levels of AMH at OTC. In 9/28 girls, FSH rose >10 E/L within 2 years after OTC. However, in 19/28 girls, FSH levels remained below 10 E/L during the three-year follow-up. In 10 girls a biphasic pattern (decrease-increase) of AMH levels could be recognized.

Conclusion: OTC only had a mild influence on pubertal development. In almost 90% of girls the pubertal development continued after unilateral ovariectomy. Ovarian insufficiency occurred in girls who were at a priori increased risk of developing ovarian insufficiency based on their hormone levels.