Reprod Biol Endocrinol. 2025 Dec 5. doi: 10.1186/s12958-025-01504-x. Online ahead of print.
ABSTRACT
BACKGROUND: More than 500 patients have received cryopreserved ovarian tissue transplantation (OTT) worldwide, resulting in over 200 live births. Although guidelines recognize OTT as an effective fertility preservation method, there is no consensus on the optimal grafting site of OTT. This systematic review and meta-analysis aim to assess whether reproductive outcomes of OTT vary across different grafting sites.
METHODS: A literature search was conducted through March, 2024, in PubMed, Embase and the Cochrane library, using the following terms: ‘patient’, ‘fertility preservation’, ‘ovarian tissue transplantation’ and ‘live birth’. Studies including 5 or more subjects were included. Two reviewers independently selected the studies, collected the data and assessed the risk of bias. Heterogeneity and publication bias were evaluated using the I² statistic and Egger’s test, respectively. A fixed-effect meta-analysis was performed only if I² was 0%, otherwise a random-effect model was applied. The primary outcome was the live birth rate (LBR). The secondary outcomes included the proportion of women who became pregnant, those who had at least one live birth, and those who underwent repeat OTT.
RESULTS: Eighteen studies including 560 women were included. The estimated LBRs after transplantation to the remaining ovary and the pelvic peritoneum were 64% (20%-130%, I² = 74%) and 31% (15%-51%, I² = 21%), respectively. The LBRs after orthotopic transplantation (defined as transplantation to the remaining ovary, the pelvic peritoneum or both sites, which allowed spontaneous pregnancy), heterotopic transplantation and combined (orthotopic + heterotopic) transplantation were 44% (25%-69%, I² = 79%), 5% (0%-21%, I² = 0%) and 23% (4%-53%, I² = 19%), respectively. No publication bias was observed.
CONCLUSION: Reproductive outcomes of OTT vary across different grafting sites. The LBR of orthotopic transplantation is higher than that of heterotopic transplantation. Additionally, the LBR of OTT to the remaining ovary is higher than that to the pelvic peritoneum. The remaining ovary may therefore be a more suitable site for women undergoing OTT to preserve future fertility.
REGISTRATION NUMBER: CRD42023447618.
PMID:41350899 | DOI:10.1186/s12958-025-01504-x
