Ovarian Transposition Research Articles

Optimizing fertility preservation using multiple modalities in a young patient with cervical cancer

Oocyte cryopreservation is the mainstay of fertility preservation in patients with malignancy; however, live birth rates after oocyte cryopreservation are lower in cancer patients than in healthy patients. Multiple modalities of fertility preservation can be combined to optimize success rates. We demonstrate a case of a 24-year-old female who was diagnosed with cervical clear cell adenocarcinoma and was advised to undergo treatment with cisplatin and radiation therapy. She strongly desired fertility preservation and opted to proceed with oocyte cryopreservation, ovarian tissue cryopreservation, and ovarian transposition. Ovarian transposition is a surgical approach to fertility preservation that preserves both fertility and gonadal function. Different modes of fertility preservation may be combined to optimize live birth rates in patients with malignancy.

Left ovarian transposition of undescended ovary with unicornuate uterus

Video Objective To educate the minimally invasive gynecologist on the rare diagnosis of an undescended ovary and to demonstrate a laparoscopic technique for ovarian transposition to facilitate trans-vaginal oocyte monitoring and retrieval. Setting Community hospital in the suburbs of Chicago. Interventions Left ovarian transposition and ovarian drilling. Conclusion Laparoscopic ovarian transposition is a feasible, safe option to facilitate oocyte retrieval in cases of undescended ovaries.

Fertility preservation strategies for rectal cancer in reproductive-age women.

Despite rectal cancer being unusual before 40, fertility preservation (FP) remains a major concern for these reproductive-age women. Treatment usually involves pelvic radiotherapy, neoadjuvant chemotherapy, and surgery of rectum and mesorectum resection, at high risk of impairing fertility in women with risks of premature ovarian failure and radio-induced uterus damage. To date, there is no consensus on FP strategy for rectal cancer. We shared experiences between oncofertility experts from a French research network Groupe de Recherche et d'Etude en Cryoconservation Ovarienne et Testiculaire about a case of rectal cancer in a young woman. Indications, advantages and disadvantages of different FP strategies were discussed: ovarian transposition, cryopreservation of ovarian cortex and oocyte vitrification. This case was the starting point that led to the development of a French multidisciplinary e-meeting for sharing experiences and for suggesting the best strategy when faced with a complex oncofertility case.

Ovarian protection and fertility preservation in women with cancer: A French national registry analysis between 2005 and 2014

ObjectiveOvarian failure is a common effect of treatment for cancer. The aim of this study was to describe the practices concerning ovarian protection and fertility preservation in young women treated for cancer. Study designWomen between 15 and 49 years old diagnosed with cancer between 2005 and 2014 were studied, abstracted from a representative French National Healthcare database. To assess practices concerning ovarian protection, gonadotropin-releasing hormone (GnRH) agonist consumption and ovarian transposition were analyzed. For fertility preservation, GnRH agonist consumption, ovarian cryopreservation and oocyte cryopreservation were analyzed. Explanatory variables were analyzed using a multilevel model. ResultsA total of 2447 women were identified. Among the 553 patients exposed to ovarian failure, 74 (13%) had ovarian protection (67 received GnRH agonists, 7 underwent ovarian transposition). Among the 227 women exposed to fertility alteration, 53 (23%) had fertility preservation (37 received GnRH agonists, 16 had ovarian or oocyte cryopreservation). Factors associated with ovarian protection were age under 40 years old (OR = 1.56 [1.5–1.62], p = 0.006) and diagnosis of breast cancer (OR = 1.15 [1.08–1.22], p < 0.001). The only factor associated with fertility preservation was breast cancer (OR = 1.17 [1.1–1.24], p < 0.001). The five-year probability of pregnancy was 3.8% and 9.8% (p = 0.26) for women with and without fertility preservation, respectively. ConclusionOver the last decade, ovarian protection and fertility preservation concerned 13% and 23%, respectively, of young French women treated for cancer. Awareness about ovarian protection and fertility preservation remain insufficient and need to be extended to improve this major aspect of cancer management.

Ovarian transposition before radiotherapy in cervical cancer patients: functional outcome and the adequate dose constraint

BackgroundThe data regarding a transposed ovary in intensity-modulated radiotherapy (IMRT) are not sufficient. Here we aim to investigate the adequate dose constraint of ovarian transposition before radiotherapy in cervical cancer patients.MethodsThis was a retrospective analysis of 118 patients with cervical cancer who received a radical hysterectomy and ovarian transposition before pelvic irradiation from April 2012 to July 2017. A total of 105 patients underwent IMRT with a limited radiation dose to the ovaries; 48 of these patients received unilateral ovary limitation, while 57 received bilateral ovary limitations. Patient follow up regarding sex hormone levels (estrogen [E2], follicle stimulating hormone [FSH]) and menopausal symptoms was completed one year after their radiation therapy.ResultsA total of 41 out of 105 patients (39.0%) who underwent IMRT with a limited radiation dose to the ovaries preserved their normal ovarian function. The cutoff dose of comparatively lower side ovarian maximum dose was 9.985Gy and the cutoff of mean dose was 5.32Gy. The optimal dose–volume constrains to ovaries was V5.5 < 29.65%. Age ≤ 38 (P = 0.001) was an independent predictors of ovarian function, while limited ovarian side numbers were excluded.ConclusionUsing IMRT, preservation of ovarian function was possible when the limited dose was as low as possible to the ovaries regardless of bilateral or unilateral limitation to the ovaries. The ovarian maximum dose of less than 9.985Gy, the mean dose less than 5.32Gy and V5.5 < 29.65% could be better at preventing ovarian dysfunction. Patients younger than 38 years old were more likely to keep normal ovarian function while limited ovarian side numbers did not appear to exert an obvious effect.

Recent Advances in Fertility Preservation and Counseling for Reproductive-Aged Women with Colorectal Cancer: A Systematic Review.

The incidence of colorectal cancer among reproductive-aged women is increasing. Concerns regarding future fertility are secondary only to concerns regarding survival and may significantly impact quality of life among reproductive-aged female cancer survivors. Fertility preservation counseling reduces long-term regret and dissatisfaction among cancer survivors. Health care providers counseling patients with colorectal cancer must understand the impact of cancer treatment on future reproductive potential. This review aims to examine the effects that colorectal cancer treatments have on female fertility and summarize existing and emerging options for fertility preservation. EMBASE, National Library of Medicine (MEDLINE)/PubMed, Cochrane Review Library were the data sources for this review. A systematic literature review was performed using exploded MeSH terms to identify articles examining the effect of surgery, chemotherapy, and radiation, as well as fertility preservation options for colorectal cancer on female fertility. Relevant studies were included. The primary outcome was the effect of colorectal cancer treatment on fertility. There are limited data regarding the impact of colorectal surgery on fertility. The gonadotoxic effects of chemotherapy on reproductive capacity depend on age at the time of chemotherapy administration, cumulative chemotherapy, radiation dose, type of agent, and baseline fertility status. Chemotherapy-induced risks for colorectal cancers are considered low to moderate, whereas pelvic radiation with a dose of 45 to 50 Gray induces premature menopause in greater than 90% of patients. Ovarian transposition may reduce but not eliminate the damaging effect of radiation on the ovaries. Embryo and oocyte cryopreservation are considered standard of care for women desiring fertility preservation, with oocyte cryopreservation no longer being considered experimental. Ovarian tissue cryopreservation remains experimental but may be an option for select patients. The use of gonadotropin-releasing hormone agonists remains controversial and has not been definitively shown to preserve fertility. The limitations of this review are the lack of randomized controlled trials and high-quality studies, as well as the small sample sizes and the use of surrogate fertility markers. Reproductive-aged women with colorectal cancer benefit from fertility preservation counseling before the initiation of cancer treatment.

Ovarian transposition before radiotherapy in cervical cancer patients: Functional outcome and the adequate dose constraint

Objective: To investigate the adequate dose constraint of ovarian transposition before radiotherapy in cervical cancer patients.

Fertility preservation in female cancer patients: current knowledge and future perspectives.

Protecting fertility in the presence of cancer has become highly significant, as the desire to give birth to a child is increasingly postponed to later in life, and long-term survival with cancer has increased. A variety of fertility-preserving methods have been developed. To find them, we performed a literature search in Medline using the key words "female fertility preservation in cancer" in December 2017. A total of 2381 different publications were found. After screening the abstracts 78 publications in English, French, or German language had been assessed as relevant (17 dealing with medical approaches, six with surgical approaches, 15 with oocyte cryopreservation, 11 with ovarian tissue cryopreservation and 29 were review articles). In general, there are medical (non-surgical) and surgical approaches. Medical approaches comprise administration of GnRH-analogues during gonad toxic oncologic treatment, and cryopreservation of oocytes after ovarian stimulation. Surgical approaches comprise traditional methods of organ-saving surgery and ovarian transposition outside of the radiation portal as well as ovary cryopreservation as standard. It is important to inquire about a prospective desire to have children with premenopausal women with cancer and comprehensively explain the fertility conserving methods available. Every premenopausal woman with cancer should be counseled about the methods of fertility protection currently available at a multiprofessional center.

Case report: interventional radiology\u2019s potential role for in vitro fertilization post ovarian transposition and pelvic radiation

IntroductionOvarian transposition is a procedure that can help preserve fertility for female patients requiring radiation in the abdominopelvic region. However, the displacement of ovaries from its original anatomic location can make oocyte retrieval challenging.Case presentationA 24-year-old nulligravid patient recently diagnosed with colorectal carcinoma [CRC] underwent ovarian transposition prior to radiation. After radiation and chemotherapy, she began in vitro fertilization [IVF] by reproductive endocrinology and infertility physicians. Right ovary demonstrated nonviability due to failed transposition and radiation. Left ovarian oocytes were not able to be harvested due to risk of left kidney puncture via transvaginal ultrasound [TVUS]. Interventional Radiology [IR] was involved and performed a transabdominal ultrasound guided egg retrieval which led to successful IVF.ConclusionThis case highlights the utility of IR-assisted transabdominal ultrasound approach for oocyte retrieval in patients with history of ovarian transposition.

Laparoscopic Ovarian Transposition in Rectal Cancer: More than Just Oncological Outcomes.

Locally advanced rectal cancer (LARC) is treated with neoadjuvant chemoradiotherapy which down stages tumor and improves complete resection rates thus reducing local recurrences. Pelvic radiotherapy improves oncological outcomes; however, it is associated with ovarian irradiation and premature menopause. This has a consequence to fertility and hormone preservation in young women diagnosed with locally advanced rectal cancer. Laparoscopic ovarian transposition is an established method to preserve ovarian function. This review discusses the technique, indications, and limitations of laparoscopic ovarian transposition in young women requiring pelvic radiotherapy.

Fertility and hormone preservation and restoration for female children and adolescents receiving gonadotoxic cancer treatments: A systematic review

Background/PurposeThe purpose of this systematic review by the American Pediatric Surgical Cancer Committee was to summarize evidence from the current medical literature regarding fertility restoration and hormone replacement for female children and adolescents treated with gonadotoxic treatments. MethodsUsing PRISMA guidelines, questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Eligible studies included those that addressed ovarian tissue cryopreservation (OTC), oocyte harvest, ovarian transposition, and ovarian tissue auto-transplantation for females under the age of 20. Four reviewers independently screened studies for eligibility, extracted data and assessed the risk of bias. Study outcomes were summarized in a narrative synthesis. ResultsTwo thousand two hundred seventy-six studies were identified by database search and manual review and 2185 were eliminated based on defined exclusion criteria. Ninety-one studies served as the basis for the systematic review. There were 1019 patients who underwent OTC with ages ranging from 0.4 to 20.4 years old, with 298 under the age of 13. Twenty patients aged 13–20 years old underwent successful oocyte harvest. Thirty-seven children underwent ovarian transposition as a means of fertility preservation. Eighteen patients underwent auto-transplantation of thawed ovarian cortical tissue that was harvested before the age of 21 years resulting in 10 live births. ConclusionsClinically accepted and experimental fertility preservation options such as OTC, oocyte cryopreservation, and ovarian transposition are available to females aged 20 years and younger who are at risk for premature ovarian insufficiency and infertility due to gonadotoxic treatments. There is a large cohort of pediatric-aged patients, with a wide variety of diagnoses and treatments, who have undergone fertility preservation. Currently, fertility and hormone restoration experience for patients who were 20- years of age or younger at the time of fertility preservation remains limited. Level of EvidenceIV.

A Case of a Laparoscopically Resected Ovarian Cyst Developed 17 Years after Ovarian Transposition

A Case of a Laparoscopically Resected Ovarian Cyst Developed 17 Years after Ovarian Transposition

Fertility preservation in Females—where are we today?

With improvement in the survival rates of cancer, Fertility Preservation is the need of the hour. The modalities for fertility preservation vary from the classical method of ovarian transposition to simple treatments like giving drugs to reduce the chances of gonadotoxicity to oocyte and ovarian tissue cryopreservation. Various factors influence the decision of the treatment in cases of cancer survivors primarily being the age of the patient and the time in hand to do the treatment. This article is a review of the options of treatment available and increasing the awareness amongst the other clinicians.

Laparoscopic Ovarian Transposition- A Review of Indications, Techniques and a Successful Case Report

Objective: Ovarian transposition involves preserving ovarian function by repositioning the ovaries out of the field of radiation. Candidates include reproductive age women who will be undergoing pelvic radiation who wish to preserve ovarian function. The two approaches to ovarian transposition include the medial and lateral approach, wherein the ovaries are transposed to the uterosacral ligaments or the anterolateral side walls, respectively. The objective is to review the indications and approaches to ovarian transposition and highlight the surgical steps through a specific case report.

Laparoscopic uterine fixation to spare fertility before pelvic radiation therapy

To describe a surgical technique for laparoscopic uterine fixation (LUF) to decrease uterine radiation therapy side effects in case of rectal or anal cancer. This video article uses a surgical case to demonstrate the detailed technique. Institutional Review Board approval was not required for this video presentation. University hospital. A 26-year-old nulliparous female patient diagnosed with rectal adenocarcinoma and liver metastases. After the completion of right hepatectomy and neoadjuvant chemotherapy with the use of the FOLFOX regimen, pelvic radiation therapy was applied before tumor excision. The patient underwent laparoscopic ovarian transposition. During the same intervention, we fixed the uterus with three late resorbable sutures into the fascia of the anterior abdominal wall as cranial as possible to remove the uterus away from the radiation field. Value and feasibility of LUF. LUF was feasible and effective. Estimated isodoses demonstrated that this intervention may decrease uterine consequences of pelvic radiotherapy. The patient did not report any specific pain or complication in the postoperative period. Three months after the completion of pelvic concurrent chemoradiation therapy, the patient had normal menstrual periods. Hormonal blood tests were satisfactory. Ultrasound showed persistent ovarian function. Considering its simplicity of realization, LUF should be discussed for reproductive-age patients before undergoing pelvic radiotherapy for anal or rectal cancer. A close collaboration is required between surgeons and radiation oncologists to optimize the treatment and to decrease side-effects of radiotherapy. Intensity-modulated radiation therapy may contribute to enhance a multimodal fertility-sparing strategy in global management of young patients.

Ovarian survival after pelvic radiation: transposition until the age of 35\xa0years

PurposeTo evaluate the effectiveness of ovarian transposition (OT) prior to radiation therapy (RT) and to evaluate the effect of age on ovarian survival (OS) after OT.MethodsWe performed a retrospective control study, with women (aged < 45 years) who underwent OT prior to pelvic radiation, versus women diagnosed with cervical cancer and treated with hysterectomy/trachelectomy and radiation therapy. All women were treated between 1989 and 2010. The 5 years OS rate was calculated, with a sub-analysis for age (25–30; 31–35 and 36–40 years). Ovarian failure was defined as climacteric complaints (with or without starting hormone replacement therapy) and/or laboratory measurements (FSH > 40 IU/L and/or estradiol < 100 pmol/L), or bilateral salpingo oophorectomy. Women were censored at recurrence.ResultsTwenty-seven women after OT and 29 controls were included. The radiation dose was 44.8 Gy (25.0–63.0 Gy) and 46.3 Gy (45.0–50.0 Gy), respectively. The 5-year ovarian survival rate was 60.3% versus controls 0% (p < 0.001 95% CI 3.48–11.50). Despite the decrease in ovarian survival after OT with increasing age, in all age groups (25–30, 30–35 and 35–40) ovarian survival after OT was significantly better compared to women without OT (p = 0.001; p = 0.004 and p = 0.000, respectively). Neither intra-vaginal radiation therapy of concomitant chemotherapy in addition to pelvic radiation significantly altered ovarian survival.ConclusionsOur data shows that ovarian transposition prior to pelvic radiation is effective in women until the age of 35 years and needs to be discussed in patients aged 36–40 years.

Laparoscopic ovarian transposition- a review of indications, techniques and expected outcomes, highlighted by a successful case report

Laparoscopic ovarian transposition- a review of indications, techniques and expected outcomes, highlighted by a successful case report

Utilization and predictors of ovarian transposition among young women with pelvic malignancies who undergo radiotherapy

Utilization and predictors of ovarian transposition among young women with pelvic malignancies who undergo radiotherapy

Vaginal Closure with EndoGIA to Prevent Tumor Spillage in Laparoscopic Radical Hysterectomy for Cervical Cancer

To demonstrate a method of vaginal closure with the EndoGIA surgical stapler (Medtronic, Istanbul, Turkey) to prevent tumor spillage in laparoscopic radical hysterectomy. A step-by-step explanation of the procedure using a video. Women's health teaching and research hospital. A 40-year-old woman with clinical stage IBI cervical squamous cell carcinoma. Laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition. Institutional ethical committee approval was not sought. However, the patient signed an informed consent that allows us to use her clinical data. Minimally invasive surgery is increasingly being used in cervical cancer surgery. However, there is a current and significant debate regardingthe safety of these methods. Colpotomy, which is the last step of laparoscopic radical hysterectomy, could be related to an increased risk for tumor spillage. Vaginal closure before colpotomy may be an option to prevent this spillage. In this method, after completion of the radical hysterectomy steps, the initial 5-mm left lower quadrant trocar was changed to a 15-mm trocar to allow for the placement of an EndoGIA with a green cartridge. The uterine manipulator was removed, and the uterus was elevated with a myoma screw. Then, the stapler was placed, and we checked that no other unintended structure was included in the jaws of the stapler before the firing. The EndoGIA surgical stapler was fired 2times to close the vagina. The stapler places 2 triple-staggered rows of titanium staples and knife blade cuts simultaneously between them. Once the vagina was divided, the stapler was released. The upper part of the vaginal cuff was excised and sent to pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with intracorporeal suturing. Vaginal closure with the EndoGIA surgical stapler before colpotomy provides a safe and easy method to prevent tumor spillage and could improve the unfavorable results related to minimally invasive surgery in patients with cervical cancer.

Application of 64-slice MSCT with ovarian vein tracking technique in identification of suture-fixed transposed ovaries

ObjectiveTo explore the accuracy of 64-slice multislice computed tomography with ovarian vein tracking technique in identification of surgically transposed ovaries. MethodsThe CT and clinical data of 84 patients with ovarian transposition were retrospectively analyzed. Two radiologists completed the assessments independently. The CT data were analyzed twice. During the first assessment, transposed ovaries were identified on both sides of the lower paracolic gutters on enhanced axial CT images. The second assessment was carried out two months later. The presence or absence of transposed ovaries was identified by ovarian vein tracking technique. If the adjacent colon of the transposed ovary was not filled with contrast agents, two radiologists measured the CT values of the solid-appearing area of the transposed ovary and the wall of the adjacent colon. Results84 patients with cervical cancer underwent ovarian transposition. There were 98 transposed ovaries and 70 non-transposed ovaries. The sensitivity, specificity and accuracy of the two assessments in identification of the ovaries were 72.4%, 98.6%, and 83.3% (first assessment), and 93.9%, 100% and 96.4% (second assessment). The sensitivity and accuracy of the two assessments were significantly different (p < 0.01). The solid-appearing area of the transposed ovaries and the wall of the adjacent colon in 33 cases showed soft tissue density. The CT values were (44.44 ± 5.78) HU and (44.50 ± 6.30) HU. The CT values were no significant difference (p > 0.05). ConclusionOvarian vein tracking technique can accurately identify the unmarked transposed ovaries, which is crucial in the diagnosis of abdominal/pelvic lesions.