NEW YORK (Reuters Health) – Ovarian follicles can often be retrieved for cryopreservation from teenage girls with Turner syndrome, a condition characterized by early ovarian failure, according to researchers in Sweden.

“A spontaneous start of puberty occurs in 15-30% of girls with Turner syndrome, but only 2-5% reach menarche with the possibility of achieving pregnancy,” Dr. Birgit Borgstrom and co-investigators write in the Journal of Clinical Endocrinology and Metabolism for January. “This indicates that young teenage girls with Turner syndrome have ovarian follicles that secrete estrogen but that they disappear prematurely.”

To identify factors associated with the presence of ovarian follicles, Dr. Borgstrom, at Karolinska University Hospital Huddinge, Stockholm, and colleagues studied 57 girls with Turner syndrome, ages 8-20 years, who underwent laparoscopy for ovarian biopsy.

Forty-seven girls had ovaries large enough for biopsy, and histological analysis showed the presence of follicles in 15. The authors note that girls ages 12-16 were more likely to have follicles, although follicles were found in patients from 10.9 to 18.3 years of age.

They identified five favors associated with the presence of follicles: chromosomal mosaicism with complete chromosomes, spontaneous menarche, spontaneous onset of puberty, low levels of follicle stimulating hormone ( 2 pmol/L).

Nevertheless, they point out that these signs were “not exclusive prognostic factors,” and that follicles were found in three patients without spontaneous puberty and in four with abnormal hormone levels.

Dr. Borgstrom’s team recommends discussing biopsy and the possibility of preserving ovarian tissue for the future when a girl with Turner syndrome is 13 or 14 years old. The discussion should include information about the risks associated with pregnancy, the possibility of chromosomal abnormalities in their offspring, and that “there is no guarantee for biological children in the future.”

Despite this preprocedural counseling, the investigators note, “recruitment of the girls for this study was easy. There seems to be a strong desire to do all that is technically possible to have the opportunity to undergo fertility treatment in the future.”

Reference:
J Clin Endocrinol Metab 2009;94:74-80.