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Fertility Preservation in Girls with Turner Syndrome: Prognostic Signs of the Presence of Ovarian Follicles

Karolinska Institutet, Departments of Pediatrics (B.B.) and Clinical Science, Intervention, and Technology (R.C., S.M., F.G., K.V., F.M., H.O.), Karolinska University Hospital Huddinge, SE 141 86 Stockholm, Sweden; and Department of Women’s and Children’s Health (H.J.), Uppsala University Hospital, SE 751 85 Uppsala, Sweden

Address all correspondence and requests for reprints to: Birgit Borgström, Department of Pediatrics, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden. E-mail: Birgit.borgstrom{at}ki.se.

Context: Many girls with Turner syndrome have follicles in their ovaries at adolescence.

Objective: Our objective was to study which girls might benefit from ovarian tissue freezing for fertility preservation.

Design: Clinical and laboratory parameters and ovarian follicle counts were analyzed among girls referred by 25 pediatric endocrinologists.

Subjects and Setting: Fifty-seven girls with Turner syndrome, aged 8–19.8 yr, were studied at a university hospital.

Interventions: Ovarian tissue was biopsied laparoscopically, studied for the presence of follicles, and cryopreserved. Blood samples were drawn for hormone measurements.

Main Outcome Measures: Presence of follicles in the biopsied tissue related to age, signs of spontaneous puberty, karyotype, and serum concentrations of gonadotropins and anti-Müllerian hormone were assessed.

Results: Ovarian biopsy was feasible in 47 of the 57 girls. In 15 of the 57 girls (26%), there were follicles in the tissue piece analyzed histologically. Six of seven girls (86%) with mosaicism, six of 22 (27%) with structural chromosomal abnormalities, and three of 28 with karyotype 45X (10.7%) had follicles. Eight of the 13 girls (62%) with spontaneous menarche had follicles, and 11 of the 19 girls (58%) who had signs of spontaneous puberty had follicles. The age group 12–16 yr had the highest proportion of girls with follicles. Normal FSH and anti-Müllerian hormone concentrations for age and pubertal stage were more frequent in girls with follicles.

Conclusions: Signs of spontaneous puberty, mosaicism, and normal hormone concentrations were positive and statistically significant but not exclusive prognostic factors as regards finding follicles.

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