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Vanacker J, Camboni A, Dath C, Van Langendonckt A, Dolmans MM, Donnez J, Amorim CA. Enzymatic isolation of human primordial and primary ovarian follicles with Liberase DH: protocol for application in a clinical setting. Fertil Steril 2011; 96:379-383.e3. [DOI: 10.1016/j.fertnstert.2011.05.075] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/10/2011] [Accepted: 05/23/2011] [Indexed: 02/04/2023]
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Amorim CA, Curaba M, Van Langendonckt A, Dolmans MM, Donnez J. Vitrification as an alternative means of cryopreserving ovarian tissue. Reprod Biomed Online 2011; 23:160-86. [DOI: 10.1016/j.rbmo.2011.04.005] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 03/10/2011] [Accepted: 04/14/2011] [Indexed: 10/18/2022]
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Jadoul P, Anckaert E, Dewandeleer A, Steffens M, Dolmans MM, Vermylen C, Smitz J, Donnez J, Maiter D. Clinical and biologic evaluation of ovarian function in women treated by bone marrow transplantation for various indications during childhood or adolescence. Fertil Steril 2011; 96:126-133.e3. [DOI: 10.1016/j.fertnstert.2011.03.108] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 03/22/2011] [Accepted: 03/31/2011] [Indexed: 11/30/2022]
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Donnez J, Squifflet J. Reply: Why we need international agreement on terms and definitions to assess clinical outcome after endometriosis surgery. Hum Reprod 2011. [DOI: 10.1093/humrep/der099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Colette S, Donnez J. Are aromatase inhibitors effective in endometriosis treatment? Expert Opin Investig Drugs 2011; 20:917-31. [DOI: 10.1517/13543784.2011.581226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Curaba M, Poels J, van Langendonckt A, Donnez J, Wyns C. Can prepubertal human testicular tissue be cryopreserved by vitrification? Fertil Steril 2011; 95:2123.e9-12. [DOI: 10.1016/j.fertnstert.2011.01.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 12/24/2010] [Accepted: 01/07/2011] [Indexed: 11/28/2022]
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Janse F, Donnez J, Anckaert E, de Jong FH, Fauser BCJM, Dolmans MM. Limited value of ovarian function markers following orthotopic transplantation of ovarian tissue after gonadotoxic treatment. J Clin Endocrinol Metab 2011; 96:1136-44. [PMID: 21289248 DOI: 10.1210/jc.2010-2188] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In young women, some treatments for cancer or other conditions (such as sickle cell anemia) may give rise to primary ovarian insufficiency. Ovarian transplantation is one of the available options for fertility preservation, with highly variable pregnancy rates. OBJECTIVE The objective of the study was to investigate markers of ovarian reserve and ovarian function in women up to 7 yr after orthotopic ovarian transplantation. Secondary objectives were to assess the relationship between markers of ovarian reserve and pregnancy rate along with the duration of ovarian function. DESIGN This was a prospective cohort study in 10 women, with a mean follow-up of 2.5 yr. SETTING The study was conducted at a university hospital in Brussels, Belgium. PATIENTS Patients included 10 women who were about to receive or had previously received gonadotoxic treatment. In seven women cryopreservation of ovarian tissue was performed before starting treatment. Subsequently autografts were orthotopically transplanted in these women. Three women, who had already developed primary ovarian insufficiency due to treatment, underwent orthotopic transplantation of ovarian allograft tissue originating from their human leukocyte antigen-compatible sisters. MAIN OUTCOME MEASURES Serum concentrations of FSH, LH, estradiol, inhibin B, and anti-Müllerian hormone (AMH) were measured. RESULTS On average, first menses took place after 4.7 months. Duration of graft functioning varied from 2 to more than 60 months. FSH concentrations remained elevated, whereas estradiol levels normalized and AMH was low to undetectable. Inhibin B varied among women and was not associated with the duration of ovarian function (hazard ratio 0.966, 95% confidence interval 0.881-1.059). Two spontaneous pregnancies occurred. Endocrine characteristics were not significantly different in these women. CONCLUSIONS Low AMH and inhibin B concentrations may suggest decreased ovarian reserve in women after ovarian transplantation. AMH and inhibin B levels may not be associated with the duration of ovarian graft function or probability to achieve a pregnancy.
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Colette S, Defrere S, Lousse JC, Van Langendonckt A, Gotteland JP, Loumaye E, Donnez J. Inhibition of steroid sulfatase decreases endometriosis in an in vivo murine model. Hum Reprod 2011; 26:1362-70. [DOI: 10.1093/humrep/der079] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Donnez J, Squifflet J, Pirard C, Demylle D, Delbaere A, Armenio L, Englert Y, Cheron AC, Jadoul P, Dolmans MM. Live birth after allografting of ovarian cortex between genetically non-identical sisters. Hum Reprod 2011; 26:1384-8. [DOI: 10.1093/humrep/der089] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dath C, Dethy A, Van Langendonckt A, Van Eyck A, Amorim C, Luyckx V, Donnez J, Dolmans M. Endothelial cells are essential for ovarian stromal tissue restructuring after xenotransplantation of isolated ovarian stromal cells. Hum Reprod 2011; 26:1431-9. [DOI: 10.1093/humrep/der073] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Amorim CA, David A, Van Langendonckt A, Dolmans MM, Donnez J. Vitrification of human ovarian tissue: effect of different solutions and procedures. Fertil Steril 2011; 95:1094-7. [DOI: 10.1016/j.fertnstert.2010.11.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 11/09/2010] [Accepted: 11/16/2010] [Indexed: 11/28/2022]
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Ploteau S, Rogez JM, Donnez J, Lengelé B. Which are the ideal donor and recipient vessels for a whole ovarian transplantation? Fertil Steril 2011; 95:751-5. [PMID: 20801437 DOI: 10.1016/j.fertnstert.2010.07.1049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 06/27/2010] [Accepted: 07/09/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare deep circumflex iliac (DCI) and deep inferior epigastric (DIE) pedicles as potential recipient vessels for a whole ovarian microvascular transplantation. DESIGN Anatomical study. SETTING Laboratory of anatomy, university center. PATIENT(S) Ten fresh human female cadavers. INTERVENTION(S) Anatomical dissections, vascular injections, histologic analysis. MAIN OUTCOME MEASURE(S) Morphological analysis of the gonadic, DCI, and DIE pedicles; diameter of the vessels at regular intervals along their entire length. Comparisons of the caliber values between receiving (DCI and DIE) and gonadic pedicles aiming to determine the optimal size match. RESULT(S) We highlight a tortuous appearance of the gonadic artery. This morphology contrasted with the venous system that included two or three straight veins, one of them being wider than the others. The gonadic vessels converge into a wider artery and vein at 5 cm from the ovary. An optimal size match existed between gonadic and DCI arteries and veins sections, in 13 of 14 gonadic pedicles. CONCLUSION(S) A safe microsurgical whole ovarian transplantation is feasible if the gonadic pedicle is harvested with a minimal length of 5 cm from the ovary. The DCI pedicle seems to have the best size match with the ovarian vessels to perform a reliable end-to-end microvascular anastomosis.
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Wyns C, Curaba M, Petit S, Vanabelle B, Laurent P, Wese JFX, Donnez J. Management of fertility preservation in prepubertal patients: 5 years' experience at the Catholic University of Louvain. Hum Reprod 2011; 26:737-47. [PMID: 21227939 DOI: 10.1093/humrep/deq387] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since prepubertal boys cannot benefit from sperm banking, a potential alternative strategy for fertility preservation involves immature testicular tissue (ITT) banking aimed at preservation of spermatogonial stem cells. Survival of spermatogonia has been demonstrated after ITT freezing, which is considered ethically acceptable. We report the results of a pilot program set up for fertility preservation in prepubertal boys. METHODS All boys undergoing ITT cryobanking from May 2005 were identified from our clinical register. Data were collected from medical files. RESULTS Testicular tissue was retrieved from 52 prepubertal patients under 12 years of age and 10 peripubertal patients aged between 12 and 16 years, in whom no spermatozoa were identified in testicular biopsies. Malignant disease accounted for 80.6% of cases; the remaining patients suffered from benign disorders requiring gonadotoxic treatments. Mean ages, Tanner stages and occurrence rates of urogenital pathology were 6.43 ± 3.32 and 14 ± 1.23 years, I and I-IV, and 13.5 and 20% for pre- and peripubertal patients, respectively. Mean volumes of removed tissue were 20.1 ± 8.6 and 42.4 ± 15.6 mm(3) for pre- and peripubertal patients, respectively. No complications occurred during or after tissue retrieval and 93.5% of referred patients accepted ITT storage. The presence of spermatogonia, and thus the potential for later tissue use, was established in all of these patients. CONCLUSIONS The majority of cryopreserved samples showed reproductive potential. Storage was accepted by most parents. All parents and children considered this fertility preservation strategy a positive approach.
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Held K, Fischer R, Baukloh V, Munne S, Xu J, Yeoman R, Lawson M, Zelinski M, Stouffer R, Lim JJ, Choi KH, Kim HJ, Song SH, Lee WS, Kim YS, Kwak IP, Lee DR, Cervello Alcaraz I, Gil-Sanchis C, Mas A, Santamaria X, Moscardo F, Sanz J, Higueras G, Sanz MA, Pellicer A, Simon C, Wyns C, Van Langendonckt A, Donnez J, Poels J. SELECTED ORAL COMMUNICATION SESSION, SESSION 22: FERTILITY PRESERVATION - BASIC, Monday 4 July 2011 15:15 - 16:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Akakubo N, Kagawa N, Yabuuchi A, Silber SJ, Yamaguchi S, Nagumo Y, Takai Y, Ishihara S, Takehara Y, Kato O, Kocent J, Hu JCY, Neri QV, Rosenwaks Z, Palermo GD, Armuand G, Rodriguez-Wallberg K, Wettergren L, Lampic C, Martinez-Soto JC, Domingo JC, Cordovilla B, Gadea J, Landeras J, Sadri-Ardekani H, Akhondi MM, van der Veen F, de Rooij DG, Repping S, van Pelt AMM, Vanacker J, Luyckx V, Dolmans MM, Amorim CA, Van Langendonckt A, Donnez J, Camboni A, Camboni A, Amorim CA, Vanacker J, Dolmans MM, Van Langendonckt A, Donnez J, Gavella M, Lipovac V, Siftar Z, Garaj-Vrhovac V, Gajski G, Gook D, Borg J, Edgar DH, Brink-van der Vlugt JJ, Van der Velden VHJ, Noordijk A, Timmer-Bosscha H, Tissing WJE, Land JA, Hollema H, Van Echten-Arends J, Alvarez JG, Gosalvez A, Velilla E, Lopez-Teijon M, Lopez-Fernandez C, Gosalvez J, Kristensen SG, Rasmussen A, Yding Andersen C, Raziel A, Friedler S, Gidoni Y, Ben Ami I, Kaufman S, Omansky A, Strassburger D, Komarovsky D, Bern O, Kasterstein E, Komsky A, Maslansky B, Ron-El R, Fujimoto A, Osuga Y, Ichinose M, Oishi H, Harada M, Koizumi M, Takemura Y, Yano T, Taketani Y, Molnar Z, Mokanszki A, Benyo M, Bazsane Kassai Z, Olah E, Jakab A, Rodriguez-Wallberg KA, Vonheim E, Gumus E, Persson I, Lundqvist M, Karlstrom PO, Hovatta O, Pasqualotto FF, Teixeira R, Medeiros GS, Canabarro C, Tonezer J, Grando APC, Borges Jr. E, Pasqualotto EB, Westphal JR, Bastings L, Beerendonk CCM, Braat DDM, Peek R, Courbiere B, Berthelot-Ricou A, Di Giorgio C, De Meo M, Roustan A, Botta A, Perrin J, Abir R, Orvieto R, Friedman O, Ben-Haroush A, Fisch B, Lawrenz B, Henes J, Henes M, Neunhoeffer E, Schmalzing M, Fehm T, Koetter I. POSTER VIEWING SESSION - MALE AND FEMALE FERTILITY PRESERVATION. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Donnez J, Silber S, Andersen CY, Demeestere I, Piver P, Meirow D, Pellicer A, Dolmans MM. Children born after autotransplantation of cryopreserved ovarian tissue. a review of 13 live births. Ann Med 2011; 43:437-50. [PMID: 21226660 DOI: 10.3109/07853890.2010.546807] [Citation(s) in RCA: 241] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION. Premature ovarian failure (POF) can occur naturally at an early age or be due to iatrogenic agents. Indeed, ovaries are very sensitive to cytotoxic treatment, especially to radiation and alkylating agents. METHODS. Several options are currently available to preserve fertility in cancer patients and allow them to conceive when they have overcome their disease: embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. Cryopreservation of ovarian tissue is the only option available for pre-pubertal girls and women who cannot delay the start of chemotherapy. FINDINGS. Since the first live birth after autotransplantation of cryopreserved ovarian tissue in humans was reported in 2004, orthotopic reimplantation has led to the birth of 13 healthy babies. Restoration of ovarian activity and prognostic factors are evaluated by comparison with 7 cases of fresh ovarian tissue transplantation. We report 13 live births after orthotopic transplantation of frozen-thawed ovarian tissue in cancer patients (n = 8) and in patients treated with high doses of chemotherapy for benign diseases (n = 2) (microscopic polyangiitis, sickle cell anemia). INTERPRETATION. Based on our review, we believe that ovarian cortex cryopreservation, associated or not with cryopreservation of immature oocytes, should be offered before gonadotoxic chemotherapy in all cases where there is a high risk of POF and where emergency IVF is not possible.
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Donnez J, Squifflet J, Jadoul P, Demylle D, Cheron AC, Van Langendonckt A, Dolmans MM. Pregnancy and live birth after autotransplantation of frozen-thawed ovarian tissue in a patient with metastatic disease undergoing chemotherapy and hematopoietic stem cell transplantation. Fertil Steril 2010; 95:1787.e1-4. [PMID: 21145049 DOI: 10.1016/j.fertnstert.2010.11.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 11/04/2010] [Accepted: 11/11/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report a live birth after orthotopic transplantation of cryopreserved ovarian tissue. DESIGN Case report. SETTING Department of Gynecology, Cliniques Universitaires Saint-Luc, Brussels. PATIENT(S) Woman with metastatic cancer who had her ovarian tissue cryopreserved in 2001 before undergoing chemotherapy and hematopoietic stem cell transplantation, resulting in premature ovarian failure. INTERVENTION(S) Orthotopic reimplantation of ovarian cortex performed 7 years after cryopreservation. MAIN OUTCOME MEASURE(S) Restoration of ovarian activity. RESULT(S) Restoration of ovarian activity was observed 3.5 months after reimplantantation, and ongoing pregnancy was diagnosed 9 months after grafting. The patient delivered a healthy baby weighing 2.830 kg. CONCLUSION(S) Our patient represents the thirteenth live birth to occur after orthotopic reimplantation of cryopreserved tissue, but the first in a woman treated for metastatic disease.
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Donnez J, Donnez O. A series of 400 laparoscopic hysterectomies for benign disease: a single center, single surgeon prospective study of complications confirming previous retrospective study. BJOG 2010. [DOI: 10.1111/j.1471-0528.2010.02667.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Donnez J, Kim SS, Albertini DF. Proceedings of the First World Congress on Fertility Preservation: executive summary. J Assist Reprod Genet 2010; 27:191-5. [PMID: 20464473 DOI: 10.1007/s10815-010-9424-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jadoul P, Querleu D, Squifflet JL, Donnez J. Recurrence during pregnancy of a conservatively treated early-stage cervical squamous cell carcinoma. Fertil Steril 2010; 95:290.e13-6. [PMID: 20655526 DOI: 10.1016/j.fertnstert.2010.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 06/16/2010] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the safety of conservative management of early cervical cancer. DESIGN Case report and analysis of literature guidelines. SETTING Academic teaching hospital. PATIENT(S) A 35-year-old, nulliparous woman treated by simple trachelectomy and pelvic lymphadenectomy for a well-differentiated, 12-mm squamous cell carcinoma infiltrating to a depth of 3 mm (stage Ib1) without lymphovascular space involvement. INTERVENTION(S) Follow-up. MAIN OUTCOME MEASURES(S) Recurrence and disease evolution. RESULT(S) Sixteen months after surgery, at 32 weeks' gestation, a local recurrence of 5 cm in diameter was diagnosed, associated with pelvic and interaortocaval lymph node involvement. Despite extensive radiotherapy, chemotherapy, and radical surgery, disease progression could not be halted. CONCLUSION(S) We report a case of early-stage cervical cancer, conservatively treated by simple trachelectomy and lymphadenectomy, that recurred although none of the known risk factors for recurrence were initially present, and despite the fact that literature guidelines were followed.
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Donnez J, Squifflet J, Pirard C, Jadoul P, Dolmans MM. Restoration of ovarian function after allografting of ovarian cortex between genetically non-identical sisters. Hum Reprod 2010; 25:2489-95. [DOI: 10.1093/humrep/deq186] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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David A, Dolmans MM, Van Langendonckt A, Donnez J, Amorim CA. Immunohistochemical localization of growth factors after cryopreservation and 3 weeks' xenotransplantation of human ovarian tissue. Fertil Steril 2010; 95:1241-6. [PMID: 20638058 DOI: 10.1016/j.fertnstert.2010.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 05/10/2010] [Accepted: 06/03/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare early follicular growth after fresh and frozen-thawed human ovarian tissue xenografting and to investigate whether expression of c-kit, kit ligand (KL), and growth differentiation factor-9 (GDF-9) is maintained after freezing and xenografting of human ovarian tissue. DESIGN Prospective experimental study. SETTING Gynecology research unit in a university hospital. ANIMAL(S) Ten nude (Swiss nu/nu) 6-week-old female mice. INTERVENTION(S) The ovarian biopsy samples were obtained from six women, aged 20 to 30 years. Fresh and frozen-thawed ovarian fragments intraperitoneally grafted into nude mice for 3 weeks. MAIN OUTCOME MEASURE(S) Histologic analysis and immunohistochemical evaluation of c-kit, KL, and GDF-9 expression before and after grafting. RESULT(S) The integrity and proportion of growing follicles increased similarly in both fresh (64%) and frozen-thawed (59%) xenografts compared with non-grafted tissue (fresh: 40%; frozen-thawed: 21%). Both C-kit and KL staining were detected in the oocytes and granulosa cells of preantral follicles, and GDF-9 expression was observed in the oocytes of preantral follicles in all groups. CONCLUSION(S) Freezing does not appear to have a major impact on early follicular growth after transplantation. This study shows, for the first time, expression of c-kit, KL, and GDF-9 in human preantral follicles after ovarian tissue cryopreservation and xenotransplantation.
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Smitz J, Dolmans MM, Donnez J, Fortune JE, Hovatta O, Jewgenow K, Picton HM, Plancha C, Shea LD, Stouffer RL, Telfer EE, Woodruff TK, Zelinski MB. Current achievements and future research directions in ovarian tissue culture, in vitro follicle development and transplantation: implications for fertility preservation. Hum Reprod Update 2010; 16:395-414. [PMID: 20124287 PMCID: PMC2880913 DOI: 10.1093/humupd/dmp056] [Citation(s) in RCA: 236] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/12/2009] [Accepted: 12/10/2009] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Female cancer patients are offered 'banking' of gametes before starting fertility-threatening cancer therapy. Transplants of fresh and frozen ovarian tissue between healthy fertile and infertile women have demonstrated the utility of the tissue banked for restoration of endocrine and fertility function. Additional methods, like follicle culture and isolated follicle transplantation, are in development. METHODS Specialist reproductive medicine scientists and clinicians with complementary expertise in ovarian tissue culture and transplantation presented relevant published literature in their field of expertise and also unpublished promising data for discussion. As the major aims were to identify the current gaps prohibiting advancement, to share technical experience and to orient new research, contributors were allowed to provide their opinioned expert views on future research. RESULTS Normal healthy children have been born in cancer survivors after orthotopic transplantation of their cryopreserved ovarian tissue. Longevity of the graft might be optimized by using new vitrification techniques and by promoting rapid revascularization of the graft. For the in vitro culture of follicles, a successive battery of culture methods including the use of defined media, growth factors and three-dimensional extracellular matrix support might overcome growth arrest of the follicles. Molecular methods and immunoassay can evaluate stage of maturation and guide adequate differentiation. Large animals, including non-human primates, are essential working models. CONCLUSIONS Experiments on ovarian tissue from non-human primate models and from consenting fertile and infertile patients benefit from a multidisciplinary approach. The new discipline of oncofertility requires professionalization, multidisciplinarity and mobilization of funding for basic and translational research.
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Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 2010; 25:1949-58. [PMID: 20547557 DOI: 10.1093/humrep/deq135] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The debate continues between advocates of the shaving technique and supporters of bowel resection in case of deep endometriosis with rectal muscularis involvement, despite little evidence for better improvement with bowel resection. METHODS We analyzed complication, pregnancy and recurrence rates after deep endometriotic nodule excision by shaving surgery. This is a prospective analysis of 500 cases (<40 years old) of deep endometriotic nodules. RESULTS Laparoscopic nodule resection was performed successfully in all cases. Major complications included: (i) rectal perforation in seven cases (1.4%); (ii) ureteral injury in four cases (0.8%); (iii) blood loss >300 ml in one case (0.2%); and (iv) urinary retention in four cases (0.8%). The median follow-up duration was 3.1 years (range 2-6 years). In our prospective series of 500 women, 388 wished to conceive. Of this number, 221 (57%) became pregnant naturally and 107 by means of IVF. In total, 328 women (84%) conceived. The recurrence rate was 8% among these 500 women, and it was significantly lower (P < 0.05) in women who became pregnant (3.6%) than in those who did not (15%). In women who failed to conceive, or were not interested in conceiving, severe pelvic pain recurred in 16-20% of patients. CONCLUSION In young women, conservative surgery using the shaving technique preserves organs, nerves and the vascular blood supply, yielding a high pregnancy rate and low complication and recurrence rates. There is a need, however, for further strong and energetic debate to weigh up the benefits of shaving (debulking surgery) versus rectal resection (radical surgery).
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