Abstract
Purpose
Extracting ovarian tissue before oncologic therapy and transplanting it afterwards are increasingly being used to preserve fertility in women. This study describes standardized and safe operative procedures, with few complications, and reports the resulting ovarian function and pregnancy rates.
Methods
The standardized operative techniques for removing and transplanting ovarian tissue used at the Erlangen center are: for tissue removal, one-third to half of the tissue from one ovary is excised with scissors, without tissue coagulation; for subsequent transplantation, pieces of ovarian tissue are placed in a retroperitoneal pocket without closure of the pocket.
Results
Between January 2007 and December 2015, ovarian tissue was extracted in 399 women and transplanted following cancer therapy in 38. No surgical complications were observed within 28 days. To date, there have been ten pregnancies and nine live births after transplantation in seven different women; 26 of the 38 women developed hormonal activity, confirmed by a menstrual cycle or raised serum estradiol levels.
Conclusions
The techniques for laparoscopic removal and transplantation of ovarian tissue described here provide a standardized method with a very low risk of complications. The pregnancy rate after ovarian tissue transplantation, currently 15–30%, can be expected to rise further in the near future.
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References
Mattle V, Behringer K, Engert A, Wildt L (2005) Female fertility after cytotoxic therapy–protection of ovarian function during chemotherapy of malignant and non-malignant diseases. Eur J Haematol Suppl 66:77–82
Anderson RA, Wallace WH, Baird DT (2008) Ovarian cryopreservation for fertility preservation: indications and outcomes (Cambridge, England). Reproduction 136:681–689
Irtan S, Orbach D, Helfre S, Sarnacki S (2013) Ovarian transposition in prepubescent and adolescent girls with cancer. Lancet Oncol 14:e601–e608
Lee MC, Gray J, Han HS, Plosker S (2010) Fertility and reproductive considerations in premenopausal patients with breast cancer. Cancer Control J Moffitt Cancer Center 17:162–172
Findeklee S, Lotz L, Heusinger K, Hoffmann I, Dittrich R, Beckmann MW (2015) Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled? Geburtshilfe Frauenheilkd 75:1243–1249
Beck-Fruchter R, Weiss A, Shalev E (2008) GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data. Hum Reprod Update 14:553–561
Blumenfeld Z, von Wolff M (2008) GnRH-analogues and oral contraceptives for fertility preservation in women during chemotherapy. Hum Reprod Update 14:543–552
Practice Committee of the American Society for Reproductive Medicine (2013) Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril 100:1214–1223
Luyckx V, Scalercio S, Jadoul P et al (2013) Evaluation of cryopreserved ovarian tissue from prepubertal patients after long-term xenografting and exogenous stimulation. Fertil Steril 100:1350–1357
Oktay K, Karlikaya G (2000) Ovarian function after transplantation of frozen, banked autologous ovarian tissue. N Engl J Med 342:1919
Krishnakumar S, Tambe P (2009) Entry complications in laparoscopic surgery. J Gynecol Endosc Surg 1:4–11
Donnez J, Dolmans MM, Pellicer A et al (2013) Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril 99:1503–1513
Donnez J, Dolmans MM (2013) Fertility preservation in women. Nat Rev Endocrinol 9:735–749
Burmeister L, Kovacs GT, Osianlis T (2013) First Australian pregnancy after ovarian tissue cryopreservation and subsequent autotransplantation. Med J Aust 198:158–159
Donnez J, Silber S, Andersen CY et al (2011) Children born after autotransplantation of cryopreserved ovarian tissue. a review of 13 live births. Ann Med 43:437–450
Dittrich R, Hackl J, Lotz L, Hoffmann I, Beckmann MW (2015) Pregnancies and live births after 20 transplantations of cryopreserved ovarian tissue in a single center. Fertil Steril 103:462–468
Rosendahl M, Greve T, Andersen CY (2013) The safety of transplanting cryopreserved ovarian tissue in cancer patients: a review of the literature. J Assist Reprod Genet 30:11–24
Dolmans MM, Jadoul P, Gilliaux S et al (2013) A review of 15 years of ovarian tissue bank activities. J Assist Reprod Genet 30:305–314
Lawrenz B, Rothmund R, Neunhoeffer E, Huebner S, Henes M (2012) Fertility preservation in prepubertal girls prior to chemotherapy and radiotherapy–review of the literature. J Pediatr Adolesc Gynecol 25:284–288
Lee PA, Rogol A, Houk CP (2011) Optimizing potential for fertility: fertility considerations for the pediatrician. Pediatr Clin N Am 58:1201–1215, x
Huober-Zeeb C, Lawrenz B, Popovici RM et al (2011) Improving fertility preservation in cancer: ovarian tissue cryobanking followed by ovarian stimulation can be efficiently combined. Fertil Steril 95:342–344
Sanchez-Serrano M, Crespo J, Mirabet V et al (2010) Twins born after transplantation of ovarian cortical tissue and oocyte vitrification. Fertil Steril 93:268.e11-13
Sanchez M, Novella-Maestre E, Teruel J, Ortiz E, Pellicer A (2008) The Valencia programme for fertility preservation. Clin Trans Oncol Off Publ Fed Span Oncol Soc Nat Cancer Inst Mexico 10:433–438
Rosendahl M, Andersen CY, Ernst E et al (2008) Ovarian function after removal of an entire ovary for cryopreservation of pieces of cortex prior to gonadotoxic treatment: a follow-up study. Hum Reprod 23:2475–2483
Schmidt KL, Andersen CY, Loft A, Byskov AG, Ernst E, Andersen AN (2005) Follow-up of ovarian function post-chemotherapy following ovarian cryopreservation and transplantation. Hum Reprod 20:3539–3546
Meirow D, Levron J, Eldar-Geva T et al (2005) Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med 353:318–321
Donnez J, Jadoul P, Squifflet J et al (2010) Ovarian tissue cryopreservation and transplantation in cancer patients. Best Pract Res Clin Obstet Gynaecol 24:87–100
Donnez J, Dolmans MM, Demylle D et al (2004) Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 364:1405–1410
Demeestere I, Simon P, Emiliani S, Delbaere A, Englert Y (2007) Fertility preservation: successful transplantation of cryopreserved ovarian tissue in a young patient previously treated for Hodgkin’s disease. Oncologist 12:1437–1442
Rosendahl M, Schmidt KT, Ernst E et al (2011) Cryopreservation of ovarian tissue for a decade in Denmark: a view of the technique. Reprod Biomed Online 22:162–171
Silber S, Kagawa N, Kuwayama M, Gosden R (2010) Duration of fertility after fresh and frozen ovary transplantation. Fertil Steril 94:2191–2196
Revel A, Laufer N, Ben Meir A, Lebovich M, Mitrani E (2011) Micro-organ ovarian transplantation enables pregnancy: a case report. Hum Reprod 26:1097–1103
Revelli A, Marchino G, Dolfin E et al (2013) Live birth after orthotopic grafting of autologous cryopreserved ovarian tissue and spontaneous conception in Italy. Fertil Steril 99:227–230
Lawrenz B, Jauckus J, Kupka MS, Strowitzki T, von Wolff M (2011) Fertility preservation in > 1,000 patients: patient’s characteristics, spectrum, efficacy and risks of applied preservation techniques. Arch Gynecol Obstet 283:651–656
Institute (2013) A Datensatz Gynäkologische Operationen
Dittrich R, Lotz L, Keck G et al (2012) Live birth after ovarian tissue autotransplantation following overnight transportation before cryopreservation. Fertil Steril 97:387–390
Imbert R, Moffa F, Tsepelidis S et al (2014) Safety and usefulness of cryopreservation of ovarian tissue to preserve fertility: a 12-year retrospective analysis. Hum Reprod 29:1931–1940
Stoop D, Cobo A, Silber S (2014) Fertility preservation for age-related fertility decline (London, England) Lancet 384:1311–1319
Rosendahl M, Andersen MT, Ralfkiaer E, Kjeldsen L, Andersen MK, Andersen CY (2010) Evidence of residual disease in cryopreserved ovarian cortex from female patients with leukemia. Fertil Steril 94:2186–2190
Dolmans MM, Luyckx V, Donnez J, Andersen CY, Greve T (2013) Risk of transferring malignant cells with transplanted frozen-thawed ovarian tissue. Fertil Steril 99:1514–1522
Author contributions
MWB: idea, conception of the manuscript, manuscript correction. RD: conception of the manuscript, figure creation, manuscript correction. LL: supervision, support in literature search. PGO: supervision. SF: literature analysis, data collection, preparation of the manuscript. TH: supervision. KH: supervision. SC: supervision. AM: supervision, figure creation.
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Beckmann, M.W., Dittrich, R., Lotz, L. et al. Operative techniques and complications of extraction and transplantation of ovarian tissue: the Erlangen experience. Arch Gynecol Obstet 295, 1033–1039 (2017). https://doi.org/10.1007/s00404-017-4311-2
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DOI: https://doi.org/10.1007/s00404-017-4311-2