Fresh human orthotopic ovarian cortex transplantation: long-term results.
BACKGROUND
Ovarian orthotopic transplantation in patients with premature ovarian failure is reported to result in full-term pregnancies. Ischaemia and freezing/thawing are potentially injurious for tissues. This study was designed to analyse the effect of ischaemia on long-term ovarian function in humans.


METHODS
Prospective case-control study. Subjects were 12 premenopausal women undergoing hysterectomy and fresh orthotopic transplantation of the entire ovarian cortex plus a control group of five patients undergoing hysterectomy only. Follow-up lasted 2 years. Serum FSH and anti-Müllerian hormone (AMH) were recorded, and ovulatory cycles were determined by vaginal ultrasound and serum progesterone levels.


RESULTS
Follow-up showed that ovulation was restored in 11 of the 12 patients who received grafts over the duration of the study (9.3 +/- 1.73 ovulations versus 12.0 +/- 0.86 in controls, NS), and 9 of 12 patients remained ovulatory after 2 years. We identified four patterns of FSH secretion during the study, 5 of 12 (41.7%) women having the same pattern as controls. There was a trend for serum AMH levels 7 days after surgery (0.16 +/- 0.02 microg/l) to be lower than pre-surgery levels (0.38 +/- 0.09 microg/l, P = 0.07) and higher in women whose FSH patterns suggested normal ovarian function, but the results did not reach significance. After transplantation, FSH correlated more closely (r = -0.639, P = 0.02) with normal ovarian function than AMH (r = 0.465, P = 0.12).


CONCLUSIONS
Fresh orthotopic ovarian cortex transplantation is a viable procedure. It maintains normal ovarian function after 2 years in 75% of cases and preserves ovarian function against ischaemia in 41.7% of patients.
Sánchez
M
M
Department of Obstetrics and Gynaecology, Hospital Universitario Dr Peset, Valencia, Spain.
Alamá
P
P
Gadea
B
B
Soares
S R
SR
Simón
C
C
Pellicer
A
A
D000328:Adult; D054304:Anti-Mullerian Hormone; D015925:Cryopreservation; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D007044:Hysterectomy; D007511:Ischemia / Q000150:complications; D008875:Middle Aged; D010053:Ovary / Q000098:blood supply / Q000637:transplantation*; D016649:Primary Ovarian Insufficiency / Q000601:surgery; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D013735:Testicular Hormones / Q000097:blood
D006023:Glycoproteins; D013735:Testicular Hormones; D011374:Progesterone; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone