Laparoscopic ovariectomy for whole human ovary cryopreservation: technical aspects

Alterations in resting energy expenditure and metabolic hormones (energy conservation) are evident in increasing magnitude across a continuum of increasing severity of clinical menstrual disturbances, including luteal-phase defects, anovulation, and amenorrhea in exercising women. These data provide further evidence of the tight association between energy balance and reproduction and suggest that subtle declines in energy availability can produce clinically recognized menstrual disturbances.     

Healthy twins delivered after oocyte cryopreservation and bilateral ovariectomy for ovarian cancer

Anti-neoplastic treatments have significantly increased the survival of cancer patients, but female patients risk premature menopause. Oocyte cryopreservation has been proposed as a fertility-saving option. This report describes the first live birth achieved with autologous cryopreserved oocytes in an ovariectomized borderline cancer patient. A patient with a borderline ovarian tumour asked for oocyte cryopreservation after a right adnexectomy. Ovulation induction resulted in the retrieval and cryopreservation of seven mature oocytes. Thirty-nine months after a left ovariectomy, the patient asked for oocyte thawing and embryo transfer. Endometrial growth was induced using hormone replacement treatment. Three of the seven cryopreserved oocytes were thawed; they survived and, after insemination, normal fertilization took place. Three embryos were transferred into the patient's uterus. A twin pregnancy was achieved with the birth of two healthy females. Oocyte cryopreservation may be a reliable option for preserving fertility in young cancer patients who risk premature menopause due to surgery, chemotherapy or radiotherapy.     

Laparoscopic ovarian transposition and cryopreservation of ovarian tissue before chemo-radiotherapy for rectal cancer

We report a case of laparoscopic ovarian transposition and ovarian cryopreservation in a nulliparous 25-year-old woman with rectal cancer. The authors focus on the surgical technique and the importance of preserving ovarian function.     

Laparoscopic ovarian tissue harvesting for cryopreservation: an effective and safe procedure for fertility preservation

Objective

To critically review our experience with the method of laparoscopic ovarian tissue harvesting for ovarian cryopreservation.

Study design

In a retrospective cohort study 85 patients undergoing surgery for cryopreservation of ovarian tissue were included. One random ovarian cortical slice was histologically examined in order to determine the presence of primordial follicles and to detect possible malignant cells. Selective microbiological culture techniques from swabs were taken from all slices immediately after excision. Intra- and postoperative courses, histological and microbiological findings were evaluated.

Results

Eighty-five patients underwent cryopreservation of ovarian tissue, mostly for malignant diseases (78/85, 91.8%). Sixty patients (70.6%) underwent laparoscopy for ovarian tissue harvesting only, without any additional surgical procedure. The median operating time was 30 min (range 10-75 min). The intraoperative course was uneventful in these patients. In two patients slight postoperative increases in C-reactive protein levels were found. Microbiological examination revealed no contamination apart from one case revealing sporadic Propionibacterium acnes. Histological examination revealed intact ovarian tissue with primordial follicles in 81/85 patients (95.3%).

Conclusion

Laparoscopy is a safe and effective procedure for ovarian tissue harvesting. We suggest microbiological and histological testing of ovarian tissue as mandatory tools to guarantee safety regarding ovarian tissue transplantation.     

Fertility preservation by ovarian tissue cryopreservation

Female fertility may be compromised after radio or chemotherapy for malignant as well as non-malignant diseases. It could be saved by cryopreservation of ovarian tissue, since it is now well established that primordial follicles can survive freezing. Many births have been obtained in rodents with thawed ovarian fragments, after grafting or in vitro folliculogenesis. Both techniques are more difficult in large animal species, and need further development to enter clinical practice. However, storing ovarian samples is already indicated, especially in younger patients who will require restoration of their fertility in a far future.     

Methods for cryopreservation of human ovarian tissue

Human ovarian tissue can be successfully cryopreserved, with good survival and function after thawing. Experimental animal studies regarding ovarian tissue cryopreservation resulting in live-born offspring preceded the present freezing systems in humans. On the basis of current knowledge, the standard method for human ovarian cryopreservation is slow programmed freezing, using human serum albumin-containing medium, and propanediol, dimethylsulphoxide (DMSO) or ethylene glycol as a cryoprotectant, combined with sucrose. Vitrification is still at the experimental stage. Whole organ cryopreservation is an interesting experimental option. Transplantation of the frozen-thawed tissue is a feasible method to utilize the tissue in infertility treatment. Ovarian function has been restored in humans. Because one healthy child has already been born from cryopreserved tissue, tissue cryopreservation should perhaps be offered to all young girls and women who can be predicted to undergo premature ovarian failure due to cancer treatment or genetic causes. Maturation of follicles in vitro from frozen-thawed tissue is another option that is still under development.     

腹腔镜在卵巢癌手术分期与治疗中的应用

腹腔镜在卵巢癌诊治中的应用目前争议较多。文章重点就腹腔镜用于卵巢癌诊断、评估、分期与补充分期手术、监测与随访等方面的现状与共识,以及腹腔镜下卵巢癌肿瘤细胞减灭术的进展和争议等问题做一阐述,希望能为临床应用与研究提供参考。     

Laparoscopic surgery for complex ovarian masses

STUDY OBJECTIVE: To assess the value of laparoscopy in managing complex ovarian masses. DESIGN: Retrospective, observational analysis (Canadian Task Force classification II-2). SETTING: University-based, tertiary level center for endoscopic surgery. PATIENTS: Two hundred eleven consecutive women. INTERVENTIONS: Laparoscopic surgery including ovary-preserving surgery, salpingo-oophorectomy, adhesiolysis, and pelvic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: Patients were selected on the basis of preoperative ultrasound findings. Intraoperative appearance of the tumors as well as results from frozen section examinations were compared with histologic results. Two hundred sixteen pelvic masses were benign. In 10 patients, early ovarian cancer, borderline tumors, tubal cancer, or secondary ovarian, nongynecologic pathology was managed primarily by laparoscopy and confirmed histologically. Three of these 10 women underwent standard radical open surgery within 1 week. The true nature of masses was not recognized at the time of laparoscopy in three patients with malignant findings. Patients with malignant tumors were followed for 5 years. CONCLUSION: Although most complex ovarian masses can be managed by laparoscopy, the possibility of overlooking malignancy remains, even with frozen section examination. Whether or not laparoscopy compromises clinical outcome compared with laparotomy is not fully understood. Prospective studies to address this important clinical question are urgently needed.     

Oocyte cryopreservation versus ovarian tissue cryopreservation for adult female oncofertility patients: a cost-effectiveness study

Journal of Assisted Reproduction and Genetics - In December 2019, the American Society for Reproductive Medicine designated ovarian tissue cryopreservation (OTC) as no longer experimental and an...     

Laparoscopic surgery for the management of ovarian endometrioma

The purpose of this study was to evaluate the effects of laparoscopic surgery on the symptoms associated with ovarian endometrioma. We also examined serum IL-6 concentrations in patients with endometrioma. Ninety-two patients who underwent laparoscopic surgery for ovarian endometrioma were enrolled in this study. The mean duration of follow-up was 27.6 months. Transvaginal ultrasound examinations revealed a recurrence of endometrioma in 13% of the cases. We evaluated the severity of dysmenorrhea using a 0-3-point verbal rating scale, and found that the dysmenorrhea score was statistically improved after the operation. Follicular growth was preserved in 94%, and the pregnancy rate was 43%. We measured serum IL-6 concentrations in 14 patients with ovarian endometrioma and 4 patients with benign gynecologic disease without endometriosis. IL-6 was significantly higher in patients with endometrioma than in those without endometriosis at the time of diagnosis. The mean serum IL-6 concentration significantly decreased after the operation. In conclusion, laparoscopic surgery is effective for alleviating pain and preserving fertility in patients with endometrioma. Measurements of serum IL-6 concentrations may be useful for the management of endometrioma.     

Laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome

Laparoscopic ovarian drilling (LOD) is an alternative to ovulation induction with gonadotropins for polycystic ovarian syndrome (PCOS) patients unresponsive to clomiphene. It is quick and easy to perform, although the number of punctures and energy doses has not been standardized. The mechanism of LOD is unclear, but it is likely mediated by a reduction in intraovarian androgen production. Serum luteinizing hormone and testosterone levels are rapidly normalized, and these changes are sustained over long-term follow-up. Studies have shown that ovulation and pregnancy rates are comparable between ovulation induction with gonadotropins and LOD, but LOD avoids the risks of multiple pregnancy and ovarian hyperstimulation syndrome. LOD is also more cost effective and better tolerated than gonadotropin therapy. Concerns regarding clinically significant adhesion formation and premature ovarian failure are not supported by the available data. Transvaginal hydrolaparoscopy and ultrasound guidance are less invasive techniques for performing ovarian drilling and may encourage LOD earlier in the course of treatment for PCOS.