Ovarian Tissue Autologous Transplantation to the Upper Extremity for Girls Receiving Abdominal/Pelvic Radiation: 20-year Follow-up of Reproductive Endocrine Function

ObjectiveUpper-extremity ovarian autologous transplantation was first used for girls undergoing abdominal/pelvic radiation therapy; long-term follow-up is provided.DesignA case series.SettingTertiary pediatric medical center.PatientsGirls with Wilms tumor with planned abdominal/pelvic radiation therapy.InterventionsSubjects 1, 2, and 3 (ages 5, 2, and 1 year) presented with a Wilms tumor and underwent surgical resection. Each patient underwent ovarian autotransplantation to move ovarian tissue out of the radiation field. Subjects 1 and 2 had thin slices from 1 ovary placed in the arm. Subject 3 had a free transfer of the entire ovary into an axilla. Follow-up was obtained for the subsequent 20-25 years for all 3 subjects.Outcome MeasuresPubertal, menarcheal, and menstrual history, and hormonal serum levels.ResultsAll subjects survived and experienced spontaneous pubertal development and menarche. Data were available for follow-up for 20-25 years. Subjects 1 and 2 showed spontaneous follicular development of the autotransplanted ovarian tissue. They had fluctuating gonadotropin and estradiol levels until age 29 and 26, respectively; spontaneous menses until age 29 and 26; and cessation of spontaneous menses with elevated gonadotropins and low estradiol levels at age 30 and 26. Subject 3 had severe monthly axillary pain, and the ovary was transferred back to the pelvis. She then had ovarian dysfunction with intermittent spontaneous ovarian activity until age 25.ConclusionsOvarian autotransplantation to the upper extremity resulted in long-term sex steroid production for spontaneous puberty, menarche, follicular development, and menses with fluctuating gonadotropin and ovarian sex steroid levels and follicular activity that lasted for 13-15 years.