title: Heterotopic autotransplantation of the ovary with microvascular anastomosis: a novel surgical technique.
abstract: OBJECTIVE
  To test the feasibility of transplanting an entire ovary with anastomosis of the ovarian vascular pedicle.
  
  
  METHODS
  Long-term survival study.
  
  
  METHODS
  Biological Resources Unit, Cleveland Clinic Foundation.
  
  
  METHODS
  Five adult, nonpregnant ewes.
  
  
  METHODS
  Laparoscopic bilateral oophorectomy was performed. Ovaries were autotransplanted into the abdominal wall, and microsurgical vascular anastomosis of the ovarian to the inferior epigastric vessels was performed. The transplant was removed and evaluated after 7 +/- 1 days.
  
  
  METHODS
  Blood flow, serum E2 and FSH levels, and histologic characteristics.
  
  
  RESULTS
  At follow-up three transplants were viable; they showed no signs of necrosis, and patency of the vascular anastomosis was confirmed. Serum E2 levels did not change significantly after transplantation in the patent vessel group (155.3 +/- 46.1 vs. 125.7 +/- 44.6 pg/mL) or the nonpatent vessel group (99 vs. 158 pg/mL). Serum FSH level in the patent vessel group did not change significantly from before to after transplantation (70.6 +/- 37.2 ng/mL vs. 95.1 +/- 17.7 ng/mL), whereas a large increase in FSH level was observed in the nonpatent vessel group (52.3 ng/mL vs. 522 ng/mL). The patent vessel group had significantly more follicles after transplantation than did the nonpatent vessel group (6 +/- 1 vs. 1 +/- 1).
  
  
  CONCLUSIONS
  In conjunction with improved protocols for cryopreservation, ovarian autotransplantation with vascular anastomosis may be superior to current ovarian tissue banking and grafting techniques.
authors.affiliation: Department of Obstetrics and Gynecology, Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jeremias
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Bedaiwy
authors.forename: Raffi
authors.initials: R
authors.lastname: Gurunluoglu
authors.forename: Charles V
authors.initials: CV
authors.lastname: Biscotti
authors.forename: Maria
authors.initials: M
authors.lastname: Siemionow
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001808:Blood Vessels / Q000473:pathology; D004958:Estradiol / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006085:Graft Survival; D008833:Microcirculation; D009336:Necrosis; D010053:Ovary / Q000098:blood supply* / Q000473:pathology / Q000637:transplantation*; D012756:Sheep; D013997:Time Factors; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic; D014654:Vascular Patency
chemical_list: D004958:Estradiol; D005640:Follicle Stimulating Hormone