Restoration of ovarian function after autotransplantation of intact frozen-thawed sheep ovaries with microvascular anastomosis.
OBJECTIVE
To test the feasibility of transplanting an intact frozen-thawed ovary with microvascular anastomosis of the ovarian vascular pedicle to the deep inferior epigastric vessels.


METHODS
Chronic survival study.


METHODS
Biological Resources Unit, The Cleveland Clinic Foundation.


METHODS
Adult merino ewes.


METHODS
Bilateral laparoscopic oophorectomy was performed on 17 synchronized ewes. In one group of animals (Group I, n = 11), both ovaries were cryopreserved intact with their vascular pedicles. In another group of animals (Group II, n = 6), ovarian cortical strips were prepared from each ovary and cryopreserved. After thawing, follicular viability and apoptosis rates were assessed using one ovary. The other ovary was transplanted to the abdominal wall with microvascular anastomosis (Group I). In Group II, the ovarian cortical strips were placed in the anterior abdominal wall. Ovaries were harvested after 8-10 days in situ and subjected to histological evaluation.


METHODS
Blood flow, apoptotic signals, follicular viability, serum estradiol (E(2)), follicle-stimulating hormone (FSH), and histology.


RESULTS
No significant differences were found in the mean values of apoptosis (mostly in the atretic and some secondary follicles) and follicular viability in both groups. In Group I, immediate and long-term patency were documented in 100% and 27% (3/11) of the grafts, respectively; and postoperative FSH levels were similar to preoperative values in animals with patent vessels. In Group II, postoperative FSH levels were significantly higher than the preoperative ones (P=.03).


CONCLUSIONS
Transplantation of an intact frozen-thawed ovary is technically feasible. Using this approach, immediate restoration of vascular supply and ovarian hormonal functions is possible.
Bedaiwy
Mohamed A
MA
Department of Obstetrics and Gynecology and Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Ohio 44195, USA.
Jeremias
Elisabeth
E
Gurunluoglu
Raffi
R
Hussein
Mahmoud R
MR
Siemianow
Maria
M
Biscotti
Charles
C
Falcone
Tommaso
T
D000714:Anastomosis, Surgical; D000818:Animals; D017209:Apoptosis; D015925:Cryopreservation; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D020287:In Situ Nick-End Labeling; D010535:Laparoscopy; D008833:Microcirculation / Q000601:surgery*; D006080:Ovarian Follicle / Q000502:physiology; D010052:Ovariectomy; D010053:Ovary / Q000098:blood supply / Q000502:physiology* / Q000637:transplantation*; D012756:Sheep; D014182:Transplantation, Autologous; D014654:Vascular Patency
D004958:Estradiol; D005640:Follicle Stimulating Hormone