Laparoscopic oophoropexy and ovarian function in the treatment of Hodgkin disease

Abstract

Hodgkin disease commonly affects women of reproductive age. Total lymph node irradiation (TNI) typically delivers a dose of 2000-4000 centigray (cGy) to the ovaries, which invariably results in premature ovarian failure (POF) and infertility unless the ovaries are shielded. Transposition of the ovaries at staging laparotomy has had mixed success and may be remote in time from pelvic radiation. A laparoscopic technique has been described that allows transposition of the ovaries just prior to pelvic radiation. This is a report of the outcome of 12 patients who underwent laparoscopic oophoropexy at the University of Florida from 1989 to 1995. Two were excluded from analysis, because one died and the other had a second malignancy for which radiation was aborted. At follow-up, five patients had evidence of ovarian function, and the four patients of these five who desired children achieved pregnancies. All five had zero to two courses of chemotherapy. Two patients who subsequently had pregnancies had staging laparotomy with oophoropexy 5 and 6 months, respectively, before laparoscopy. In both cases the ovaries had migrated back to their original positions, and their therapy would have resulted in ovarian failure had the repeat procedure not been performed. Five patients had ovarian failure at follow-up. Four of the five had received multiple courses of chemotherapy; the other had pelvic primary disease and received 3500 cGy to the femoral lymph nodes and pelvis, with little central shielding. Laparoscopic oophoropexy performed immediately prior to pelvic irradiation is effective in preserving ovarian function in nearly all patients who are to undergo TNI for Hodgkin disease and who receive minimal or no chemotherapy.