This study aimed to synthesize the existing evidence on perinatal outcomes after autologous cryopreserved ovarian tissue transplantation, concurrently identifying key factors influencing these outcomes. A comprehensive search was performed on MEDLINE, Embase, and Cochrane Library databases to identify relevant studies on the effect of autologous cryopreserved ovarian tissue transplantation on perinatal outcomes from inception to October 22, 2023. Where there was missing information, the authors were contacted for updated data. Observational studies, such as cohort studies, case series, and case reports that reported a live birth after autologous cryopreserved ovarian tissue transplantation, were considered eligible. Studies lacking data on women’s demographic characteristics, autologous cryopreserved ovarian tissue transplantation procedure details, or perinatal outcomes were excluded. In addition, cases involving fresh or nonautologous transplantations and those addressing primary ovarian insufficiency were excluded. Two reviewers (M.E. and E.U.) independently performed the study selection, data extraction, and risk of bias assessment, and the results were then reviewed together. The PRISMA guidelines were followed, and the protocol was registered on PROSPERO (CRD42023469296). This review included 58 studies composed of 122 women with 162 deliveries (154 singletons and 8 twins) after autologous cryopreserved ovarian tissue transplantation, resulting in 170 newborns. Of note, 83.6% of the women had a malignant disease. Moreover, most of these women (51.0%) were exposed to some form of chemotherapy before ovarian tissue cryopreservation. Of the 162 childbirths, 108 (66.7%) were conceived naturally, and 54 (33.3%) were conceived through assisted reproductive techniques. The birthweight of 88.5% of newborns was appropriate for gestational age, whereas 8.3% and 3.1% were small for gestational age and large for gestational age, respectively. The preterm birth rate was 9.4%, with the remaining being term deliveries. Hypertensive disorders of pregnancy were noted in 18.9% of women, including pregnancy-induced hypertension in 7.6%, preeclampsia in 9.4%, and hemolysis, elevated liver enzymes, and low platelet count in 1.9%. The incidences of gestational diabetes mellitus and preterm premature rupture of membranes were 3.8% for each condition. Neonatal anomalies were reported in 3 transplant recipients with 4 newborns: arthrogryposis, congenital cataract, and diaphragmatic hernia in a twin. Finally, among the recipients’ characteristics, not receiving chemotherapy before ovarian tissue cryopreservation (odds ratio, 0.23; 95% confidence interval, 0.07–0.72; =.012) and natural conception (odds ratio, 0.29; 95% confidence interval, 0.09–0.92; =.035) were associated with a lower perinatal complication rate. On the basis of low certainty evidence from observational studies, perinatal complication rates did not increase after autologous cryopreserved ovarian tissue transplantation compared with the general pregnant population, except for preeclampsia. This could be due to chemotherapy exposure, underlying medical conditions, and the common use of assisted reproductive techniques. Further larger studies are needed to explore the causes of increased preeclampsia incidence in autologous cryopreserved ovarian tissue transplantation pregnancies.

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自体冷冻卵巢组织移植后妊娠的围产期结局：系统评价和汇总分析

本研究旨在综合自体冷冻卵巢组织移植后围产期结局的现有证据，同时确定影响这些结局的关键因素。对 MEDLINE、Embase 和 Cochrane 图书馆数据库进行了全面检索，以识别从开始到 2023 年 10 月 22 日自体冻存卵巢组织移植对围产期结局影响的相关研究。如果信息缺失，我们会联系作者以获取最新信息数据。观察性研究，例如报告自体冷冻卵巢组织移植后活产的队列研究、病例系列和病例报告，被认为是合格的。缺乏有关女性人口特征、自体冷冻卵巢组织移植手术细节或围产期结局数据的研究被排除在外。此外，涉及新鲜或非自体移植的病例以及解决原发性卵巢功能不全的病例也被排除在外。两名评审员（ME 和 EU）独立进行研究选择、数据提取和偏倚风险评估，然后共同评审结果。遵循 PRISMA 指南，该方案已在 PROSPERO 上注册（CRD42023469296）。该综述纳入了 58 项研究，涉及 122 名妇女，在自体冷冻卵巢组织移植后进行了 162 次分娩（154 名单胎和 8 名双胞胎），共产下 170 名新生儿。值得注意的是，83.6%的女性患有恶性疾病。此外，这些女性中的大多数（51.0%）在卵巢组织冷冻保存之前接受过某种形式的化疗。在162例分娩中，108例（66.7%）是自然受孕，54例（33.3%）是通过辅助生殖技术受孕。 88.5%的新生儿出生体重符合胎龄，小于胎龄的占8.3%，大于胎龄的占3.1%。早产率为9.4%，其余为足月分娩。 18.9%的女性患有妊娠期高血压疾病，其中妊娠高血压综合征占7.6%，先兆子痫占9.4%，溶血、肝酶升高和血小板计数低占1.9%。妊娠期糖尿病和早产胎膜早破的发生率均为 3.8%。 3 名移植受者的 4 名新生儿报告了新生儿异常：双胞胎中有关节弯曲、先天性白内障和膈疝。最后，在受者特征中，卵巢组织冷冻保存前未接受化疗（比值比，0.23；95% 置信区间，0.07–0.72；=.012）和自然受孕（比值比，0.29；95% 置信区间，0.09– 0.92；=.035) 与较低的围产期并发症发生率相关。根据观察性研究的低质量证据，与一般妊娠人群相比，自体冻存卵巢组织移植后围产期并发症发生率并未增加，但先兆子痫除外。这可能是由于化疗暴露、潜在的医疗状况以及辅助生殖技术的普遍使用。需要进一步更大规模的研究来探讨自体冷冻卵巢组织移植妊娠中子痫前期发病率增加的原因。