title: Operative techniques and complications of extraction and transplantation of ovarian tissue: the Erlangen experience.
abstract: OBJECTIVE
  Extracting ovarian tissue before oncologic therapy and transplanting it afterwards are increasingly being used to preserve fertility in women. This study describes standardized and safe operative procedures, with few complications, and reports the resulting ovarian function and pregnancy rates.
  
  
  METHODS
  The standardized operative techniques for removing and transplanting ovarian tissue used at the Erlangen center are: for tissue removal, one-third to half of the tissue from one ovary is excised with scissors, without tissue coagulation; for subsequent transplantation, pieces of ovarian tissue are placed in a retroperitoneal pocket without closure of the pocket.
  
  
  RESULTS
  Between January 2007 and December 2015, ovarian tissue was extracted in 399 women and transplanted following cancer therapy in 38. No surgical complications were observed within 28 days. To date, there have been ten pregnancies and nine live births after transplantation in seven different women; 26 of the 38 women developed hormonal activity, confirmed by a menstrual cycle or raised serum estradiol levels.
  
  
  CONCLUSIONS
  The techniques for laparoscopic removal and transplantation of ovarian tissue described here provide a standardized method with a very low risk of complications. The pregnancy rate after ovarian tissue transplantation, currently 15-30%, can be expected to rise further in the near future.
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
authors.forename: Matthia W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany. ralf.dittrich@uk-erlangen.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Dittrich
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Lotz
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Oppelt
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Findeklee
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hildebrandt
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Heusinger
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Cupisti
authors.affiliation: Department of Gynecology and Obstetrics, Klinikum Karlsruhe, Karlsruhe, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
mesh_terms: D000328:Adult; D015925:Cryopreservation / Q000379:methods; D005260:Female; D005298:Fertility; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D050498:Live Birth; D010053:Ovary / Q000637:transplantation*; D011247:Pregnancy; D018873:Pregnancy Rate
keywords: Fertility preservation; Oncofertility; Ovarian tissue extraction; Ovarian tissue transplantation; Surgical techniques