Reviewer ’s report  
 
Title: A case report and follow -up o f the first live birth after heterotopic transplantation of 
cryopreserved ovarian tissue in Eastern Europe   
 
Version: 0 Date: 22 Feb 2019  
 
Reviewer: Christiani Amorim  
 
Reviewer's report:  
 
A case report and follow -up of the first live birth after transplantation of cryopreserved ovarian 
tissue in Eastern Europe. Tammiste et al.  
 
Manuscrip t overview:  
The goal of this manuscript was to report the first livebirth in Eastern Europe after 
cryopreservation and transplantation of ovarian tissue.  While this is an interesting case and I 
firmly believe that every livebirth using this procedure sho uld be documented, there are a few 
details that should be added in this manuscript before its publication.  
 
General comments:  
- Please mention the size of the frozen fragments (L107).  
- Was there any follow up of the patient regarding her levels of estrad iol, FSH and AMH in the 
period after cancer treatment and before tissue transplantation?  
- Please explain the choice of grafting location.  
- Spontaneous restoration of the function of the remaining ovarian tissue after transplantation 
procedure should be d iscussed a bit more as this is an interesting finding. Please see the study of 
Batchvarov et al. (Mol Hum Reprod, 22:1 -10, 2016) on rescue of the remaining ovarian tissue 
after grafting. It seems that the grafted tissue somehow affect the original tissue e ither by 
rescuing follicles or through formation of new follicles (see Tilly's papers).  
- In the last Discussion paragraph, the authors mention that "further information from bigger 
patients' cohorts is needed, and long -term follow -up studies are required  to draw the valid 
conclusions whether ovarian tissue transplantation is safe and ensures the long -term health of 
offspring". There are already some interesting studies on this topic. Please read and discuss: 
Gellert et al. (J Assist Reprod Genet, 35:561 -570, 2018), Jensen et al. (Hum Reprod, 32:154 -164, 
2017), Jadoul et al. (Hum Reprod, 32:1046 -1054, 2017), Donnez and Dolmans (N Engl J Med, 
377:1657 -1665, 2017), van der Ven et al. (Hum Reprod, 31:2031 -2041, 2016) and Pacheco and 
Oktay (Reprod Sci, 24:1111 -1120, 2017).  
Are the methods appropriate and well described?  
If not, please specify what is req uired in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publi cation of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you curr ently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any  other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named rep ort 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal