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- Title
Ovarian tissue transplantation.
- Authors
Lornage, J.; Salle, B.
- Abstract
Ovary tissue freezing--thawing is still under evaluation, but presently seems to be the best means of restoring fertility in young women who have undergone treatment such as chemotherapy or radiotherapy. The freezing and transplantation procedures, however, are as yet far from being reproducible or standardized, and much further clinical and fundamental study will be needed for ovary autograft to become a routine option. Primordial follicle survival is around 90% in slow freezing--thawing procedures, whether in fragments or hemiovaries. Gosden was the first to report a gestation and a live birth after frozen--thawed ovarian fragments transplantation into ewes. We have reported many gestations and live birth after frozen--thawed hemi ovary transplantation into the same species. Hemi ovary is frozen in order to be able to restore a large number of primordial follicles. Several transplantations of frozen--thawed ovarian tissue have been reported into women. In 2004, Oktay reported a laparoscopic grafting to the pelvis in a 29-year-old woman who had undergone bilateral ovarectomy for a non-malign pathology; the patient underwent gonadotrophin stimulation, and ovulation was obtained, as seen on ultrasound scan and hormonal assay. In 2001, Radford reported a menstrual episode following autograft in a patient with Hodgkin's disease. Donnez et al. were the first to report successful frozen ovary tissue transplantation; which resulted in pregnancy and birth. The 25-year-old patient had been treated for stage IV Hodgkin's diseases. Thirty-five small cubes of frozen--thawed ovarian tissue were implanted into a furrow previously cut into the abdominal peritoneum. Four months post-transplant, a follicle could be observed, and the patient conceived 11 months after autotransplantation. Meirow et al. reported a second pregnancy with live birth, using an original technique that involved placing a mixture of ovarian tissue and frozen--thawed ovarian tissue strips under the ovarian cortex. IVF with embryo transfer enabled pregnancy and the birth of a healthy baby weighing 3 kg. In 2005, Schmidt reported three cases of ovary graft; all three patients recovered ovarian function, as confirmed by restored menstrual cycles, follicles visible on US, and normal hormone levels. Two embryos were obtained, although no pregnancy followed embryo transfer. In 2000, Demeestere reported a pregnancy following natural conception in a woman who had undergone ortho- and heterotopic transplantation; follicles developed in all grafts, with just one dominant follicle at the pelvic site. US scan confirmed an intrauterine pregnancy, which led to stillbirth at 7 weeks. The question regarding heterotopic transplantation of cryopreserved ovarian tissue is whether it is a better option than orthotopic transplantation. There have so far been only six reports of heterotopic grafts in humans, and no pregnancies Cryopreservation of ovarian tissue should now be taken seriously for all patients undergoing treatment that may threaten fertility; the indications are benign or malignant pelvic or general pathology requiring radio- or chemo-therapy. Patients involved in an ovary cryopreservation programme may be post- or pre-pubescent. Current research should focus on improving freezing and vitrification protocols in the culture medium and on grafting technique.
- Subjects
TRANSPLANTATION of organs, tissues, etc.; DRUG therapy
- Publication
Reproductive BioMedicine Online (Reproductive Healthcare Limited), 2008, Vol 16, Issue S2, pS-12
- ISSN
1472-6483
- Publication type
Abstract