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Silber SJ, Goldsmith S, Castleman L, Hayashi K. In Vitro Maturation, In Vitro Oogenesis, and Ovarian Longevity. Reprod Sci 2024; 31:1234-1245. [PMID: 38160209 PMCID: PMC11090930 DOI: 10.1007/s43032-023-01427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
This paper will review a remarkable new approach to in vitro maturation "IVM" of oocytes from ovarian tissue, based on our results with in vitro oogenesis from somatic cells. As an aside benefit we also have derived a better understanding of ovarian longevity from ovary transplant. We have found that primordial follicle recruitment is triggered by tissue pressure gradients. Increased pressure holds the follicle in meiotic arrest and prevents recruitment. Therefore recruitment occurs first in the least dense inner tissue of the cortico-medullary junction. Many oocytes can be obtained from human ovarian tissue and mature to metaphase 2 in vitro with no need for ovarian stimulation. Ovarian stimulation may only be necessary for removing the oocyte from the ovary, but this can also be accomplished by simple dissection at the time of ovary tissue cryopreservation. By using surgical dissection of the removed ovary, rather than a needle stick, we can obtain many oocytes from very small follicles not visible with ultrasound. A clearer understanding of ovarian function has come from in vitro oogenesis experiments, and that explains why IVM has now become so simple and robust. Tissue pressure (and just a few "core genes" in the mouse) direct primordial follicle recruitment and development to mature oocyte, and therefore also control ovarian longevity. There are three distinct phases to oocyte development both in vitro and in vivo: in vitro differentiation "IVD" which is not gonadotropin sensitive (the longest phase), in vitro gonadotropin sensitivity "IVG" which is the phase of gonadotropin stimulation to prepare for meiotic competence, and IVM to metaphase II. On any given day 35% of GVs in ovarian tissue have already undergone "IVD" and "IVG" in vivo, and therefore are ready for IVM.
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Affiliation(s)
- Sherman J Silber
- Infertility Center of St. Louis at St. Luke's Hospital, St. Louis, MO, 63017, USA.
| | - Sierra Goldsmith
- Infertility Center of St. Louis at St. Luke's Hospital, St. Louis, MO, 63017, USA.
| | - Leilani Castleman
- Infertility Center of St. Louis at St. Luke's Hospital, St. Louis, MO, 63017, USA
| | - Katsuhiko Hayashi
- Department of Genome Biology, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan
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Recurrence Rates for Pediatric Benign Ovarian Neoplasms. J Pediatr Adolesc Gynecol 2023; 36:160-166. [PMID: 36496105 DOI: 10.1016/j.jpag.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE To examine the recurrence rates of pediatric benign ovarian neoplasms METHODS: A retrospective review of females up to 21 years of age who underwent surgery for a benign ovarian neoplasm at 8 pediatric hospitals from January 2010 through December 2016 was conducted. Data include primary operation details, follow-up imaging, and reoperation details. RESULTS Four hundred and twenty-six females were included in our cohort, with a median age of 15 years at the time of the primary operation. Of the patients, 69% had a mature teratoma, 18% had a serous cystadenoma, and 8% had a mucinous cystadenoma. Two-thirds of patients underwent ovarian-sparing surgery. There were 11 pathologically confirmed recurrences (2.6%) at a median follow-up of 12.8 months. The pathologically confirmed recurrence was 10.5 per 100 person-months at 12 months (SE = 5.7) for mucinous cystadenomas and 0.4 months (SE = 0.4) for mature teratomas (P = .001). For half of the patients, the pathologically confirmed recurrences occurred by 12.8 months, and for 75%, they occurred by 23.3 months. There were no differences in reoperation or recurrence on the basis of initial procedure (ovary-sparing surgery vs oophorectomy). CONCLUSION We measured the pathologically confirmed recurrence rate for pediatric benign ovarian neoplasms in a large cohort. Oophorectomy was not protective against recurrence. Mucinous cystadenomas were at a greater risk of pathologically confirmed recurrence.
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Lucchetti MC, Diomedi-Camassei F, Orazi C, Tassi A. A Rare Ovarian Tumor: The Sclerosing Stromal You Do Not Expect-A Case Series in the Adolescent Population and a Literature Review. Pediatr Rep 2023; 15:20-32. [PMID: 36649004 PMCID: PMC9844338 DOI: 10.3390/pediatric15010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Sclerosing stromal tumor (SST) is a rare ovarian tumor arising from the sex cord-stromal cells that occurs mainly in young adults during the second and third decades of life and rarely in pediatric and adolescent populations. The objective of this study is to report three illustrative cases of SST in young girls who had undergone surgery at our clinic in or after 2009, and to perform a literature review of this rare ovarian tumor. A retrospective chart review of female patients aged <18 years with a diagnosis of SST treated in a tertiary pediatric hospital was performed. Furthermore, a 10-year review of the SST literature was completed. Three cases of SST at our institution were outlined. After reviewing the literature, 18 SST cases were identified. The mean age at diagnosis was 13.4 years, and the reported clinical presentations were abdominal or pelvic pain and menstrual irregularity. Seven patients had abnormal hormone tests or CA-125 levels. In approximately 30% of cases, conservative surgery was performed, preserving residual ovarian tissue. In conclusion, some preoperative findings may help in suggesting the presence of SST. However, definitive diagnosis can only be made by histopathological examination. It is important to consider this tumor because, given its benign behavior, a conservative approach is preferred, particularly in this age group.
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Affiliation(s)
- Maria Chiara Lucchetti
- Andrological Surgery Unit, Pediatric Gynecology, Department of Surgery, Bambino Gesù Children’s Hospital, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Piazza S.Onofrio 4, 00165 Rome, Italy
- Correspondence: (M.C.L.); (A.T.)
| | - Francesca Diomedi-Camassei
- Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Piazza S.Onofrio 4, 00165 Rome, Italy
| | - Cinzia Orazi
- Department of Diagnostic Imaging, Bambino Gesù Children’s Hospital, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Piazza S.Onofrio 4, 00165 Rome, Italy
| | - Alice Tassi
- Clinic of Obstetrics and Gynaecology, University Hospital of Udine, P.le S.Maria Della Misericordia, 33100 Udine, Italy
- Correspondence: (M.C.L.); (A.T.)
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Failure of Operative Therapy after Ovarian-Sparing Surgery for Pediatric Benign Ovarian Neoplasms: A Retrospective Review. J Pediatr Adolesc Gynecol 2022; 35:702-706. [PMID: 36031113 DOI: 10.1016/j.jpag.2022.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To evaluate failure of initial operative therapy (incomplete tumor removal) of ovarian-sparing surgery for pediatric benign ovarian neoplasms. METHODS A retrospective review of patients up to 21 years of age who underwent ovarian-sparing surgery for a benign ovarian neoplasm from 2010 to 2016 at 8 pediatric hospitals was conducted. Failure of initial operative therapy is defined as a radiologically suspected or pathologically confirmed ipsilateral lesion with the same pathology as the primary neoplasm within 12 weeks of the initial operation. RESULTS Forty patients received imaging within 12 weeks of their primary operation. Sixteen (40%) patients had a radiologically identified ovarian abnormality ipsilateral to the primary lesion, and 5 patients were suspected to have the same lesion as their primary neoplasm. Three of the 5 patients (7.5%) underwent reoperation with pathologic confirmation of the same lesion, resulting in a pathologically confirmed failure of therapy rate of 7.5%. The other 2 patients had serial imaging that subsequently demonstrated no recurrence with lesion resolution. Age, race/ethnicity, laparoscopy vs laparotomy, presence of torsion, pathology, size of lesion, and surgeon specialty were not associated with failure of therapy. CONCLUSION In most patients who received imaging within 12 weeks of the primary operation for resection of a benign ovarian neoplasm, ovarian-sparing surgery was successful in complete tumor removal, with a low failure of therapy rate. Selected patients with suspected failure of therapy on initial imaging could be serially monitored to determine the need for repeat surgical intervention.
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Auran E, Cascante S, Blakemore J. Two is not always greater than one: patients with one ovary have similar assisted reproductive technology (ART) outcomes compared to patients with two ovaries. J Assist Reprod Genet 2022; 39:1789-1796. [PMID: 35716337 PMCID: PMC9428067 DOI: 10.1007/s10815-022-02534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 06/04/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To assess assisted reproductive technology (ART) outcomes in patients with one ovary compared to two ovaries. METHODS We performed a retrospective cohort study of all patients with one ovary who underwent ≥ 1 ART cycle between 2012 and 2020 at a large university-affiliated fertility center. Patients were 3-to-1 matched with two ovary controls during the same period. Primary outcome was metaphase II oocytes (MIIs) retrieved per cycle. Secondary outcomes included ovarian reserve markers, laboratory outcomes, and live birth rates (LBRs). RESULTS A total of 104 one ovary patients (158 cycles; median age 35.5 years) were matched to 312 two ovary patients (474 cycles; median age 35.0 years). In one ovary patients, anti-Mullerian hormone was lower (median 1.1 vs. 2.2, p < 0.01) and day 2 follicle-stimulating hormone was higher (median 7.4 vs. 6.2, p < 0.01). One ovary patients yielded median 7.5 MIIs and 10 oocytes per cycle, fewer than two ovary patients (11.0 and 14.5, respectively; p < 0.01). However, one ovary patients had ≥ 50% the MII and oocyte yield of two ovary patients (Z > 5.8, p < 0.01). Fertilization and blastocyst formation rates, euploidy rate, and rate of ≥ 1 embryo for transfer were equivalent between groups (p > 0.40). Among the one and two ovary groups, LBRs per transfer (45.8% vs. 46.6%, p = 1.00) and per patient who underwent transfer (68.3% vs. 73.9%, p = 0.55) were equivalent. CONCLUSION One ovary patients yielded fewer MIIs and oocytes than two ovary patients, but had ≥ 50% the yield of two ovary patients, suggesting a compensatory mechanism in oocyte yield in the solitary ovary. One and two ovary patients had equivalent LBRs.
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Affiliation(s)
- Emily Auran
- grid.137628.90000 0004 1936 8753New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Sarah Cascante
- grid.137628.90000 0004 1936 8753New York University Langone Fertility Center, 660 First Avenue, 5th Floor, New York, NY 10016 USA
| | - Jennifer Blakemore
- grid.137628.90000 0004 1936 8753New York University Langone Fertility Center, 660 First Avenue, 5th Floor, New York, NY 10016 USA
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Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Merchant N, Elliott Overman R, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Scannell M, Schikler AG, Sujka JA, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ. Laparoscopy versus laparotomy for pediatric ovarian dermoids. J Pediatr Surg 2022; 57:1008-1012. [PMID: 35292164 DOI: 10.1016/j.jpedsurg.2022.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND With increased surgeon comfort using laparoscopy, we hypothesized resection of pediatric ovarian dermoids using laparoscopy would yield a shorter length of stay and no increase in morbidity or recurrence compared to laparotomy. METHODS A retrospective review was performed amongst eleven pediatric hospitals. Patients aged 2 to 21 who underwent resection of an ovarian dermoid from 2010 to 2020 were included. Patient characteristics, operative details, and outcomes by approach were evaluated using Chi-squared and Wilcoxon-Mann tests. RESULTS 466 patients were included, with a median age of 14.4 and median follow-up of 4.0 months. 279 patients underwent laparoscopy (60%), 139 laparotomy (30%), and 48 laparoscopy converted to laparotomy (10%). There were no differences in rates of tumor spillage by approach (p = 0.15). 65% underwent ovarian-sparing surgery and 35% underwent oophorectomy. Length of stay was significantly shorter amongst patients who underwent laparoscopy (1 day versus 2 days for laparotomy and converted, p<0.0001). There were no differences in rates of suspected recurrence or reoperation (p = 0.19 and p = 0.57, respectively). CONCLUSION Patients who underwent laparoscopy experienced no differences in the rates of tumor spillage, recurrence, or reoperation and had a shorter length of stay compared to laparotomy. Laparoscopy is an acceptable approach for resection of pediatric ovarian dermoids.
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Affiliation(s)
- Maria E Knaus
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Amanda J Onwuka
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Amin Afrazi
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Lesley Breech
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kristine S Corkum
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Patrick A Dillon
- St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Peter F Ehrlich
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Mary E Fallat
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, United States
| | - Jason D Fraser
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Samir K Gadepalli
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Julia E Grabowski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Paige Hertweck
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, United States
| | - Rashmi Kabre
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Dave R Lal
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Matthew P Landman
- Riley Hospital for Children, Indiana University Health, Indianapolis, IN, United States
| | - Amy E Lawrence
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Charles M Leys
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Grace Z Mak
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Troy A Markel
- Riley Hospital for Children, Indiana University Health, Indianapolis, IN, United States
| | - Naila Merchant
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - R Elliott Overman
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brooks L Rademacher
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Manish T Raiji
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Beth Rymeski
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Thomas T Sato
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Madeline Scannell
- St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Allegra G Schikler
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, United States
| | - Joseph A Sujka
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Tiffany Wright
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, United States
| | - Jennifer H Aldrink
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Geri D Hewitt
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Peter C Minneci
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - Katherine J Deans
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
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Björvang RD, Hallberg I, Pikki A, Berglund L, Pedrelli M, Kiviranta H, Rantakokko P, Ruokojärvi P, Lindh CH, Olovsson M, Persson S, Holte J, Sjunnesson Y, Damdimopoulou P. Follicular fluid and blood levels of persistent organic pollutants and reproductive outcomes among women undergoing assisted reproductive technologies. ENVIRONMENTAL RESEARCH 2022; 208:112626. [PMID: 34973191 DOI: 10.1016/j.envres.2021.112626] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Persistent organic pollutants (POPs) are industrial chemicals resistant to degradation and have been shown to have adverse effects on reproductive health in wildlife and humans. Although regulations have reduced their levels, they are still ubiquitously present and pose a global concern. Here, we studied a cohort of 185 women aged 21-43 years with a median of 2 years of infertility who were seeking assisted reproductive technology (ART) treatment at the Carl von Linné Clinic in Uppsala, Sweden. We analyzed the levels of 9 organochlorine pesticides (OCPs), 10 polychlorinated biphenyls (PCBs), 3 polybrominated diphenyl ethers (PBDEs), and 8 perfluoroalkyl substances (PFASs) in the blood and follicular fluid (FF) samples collected during ovum pick-up. Impact of age on chemical transfer from blood to FF was analyzed. Associations of chemicals, both individually and as a mixture, to 10 ART endpoints were investigated using linear, logistic, and weighted quantile sum regression, adjusted for age, body mass index, parity, fatty fish intake and cause of infertility. Out of the 30 chemicals, 20 were detected in more than half of the blood samples and 15 in FF. Chemical transfer from blood to FF increased with age. Chemical groups in blood crossed the blood-follicle barrier at different rates: OCPs > PCBs > PFASs. Hexachlorobenzene, an OCP, was associated with lower anti-Müllerian hormone, clinical pregnancy, and live birth. PCBs and PFASs were associated with higher antral follicle count and ovarian response as measured by ovarian sensitivity index, but also with lower embryo quality. As a mixture, similar findings were seen for the sum of PCBs and PFASs. Our results suggest that age plays a role in the chemical transfer from blood to FF and that exposure to POPs significantly associates with ART outcomes. We strongly encourage further studies to elucidate the underlying mechanisms of reproductive effects of POPs in humans.
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Affiliation(s)
- Richelle D Björvang
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden.
| | - Ida Hallberg
- Department of Clinical Sciences, Division of Reproduction, The Centre for Reproductive Biology in Uppsala, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden
| | - Anne Pikki
- Carl von Linnékliniken, 751 83 Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Lars Berglund
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, 751 22 Uppsala, Sweden
| | - Matteo Pedrelli
- Cardio Metabolic Unit, Department of Laboratory Medicine and Department of Medicine, Karolinska Institutet, Huddinge, 141 52 Stockholm, Sweden; Medicine Unit Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Hannu Kiviranta
- Department of Health Security, Finnish Institute for Health and Welfare, 70701 Kuopio, Finland
| | - Panu Rantakokko
- Department of Health Security, Finnish Institute for Health and Welfare, 70701 Kuopio, Finland
| | - Päivi Ruokojärvi
- Department of Health Security, Finnish Institute for Health and Welfare, 70701 Kuopio, Finland
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 223 61 Lund, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Sara Persson
- Department of Clinical Sciences, Division of Reproduction, The Centre for Reproductive Biology in Uppsala, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden
| | - Jan Holte
- Carl von Linnékliniken, 751 83 Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Ylva Sjunnesson
- Department of Clinical Sciences, Division of Reproduction, The Centre for Reproductive Biology in Uppsala, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden
| | - Pauliina Damdimopoulou
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
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Rodriguez-Wallberg KA, Nilsson HP, Lind T. Live birth and pregnancy rates after in vitro fertilization/intracytoplasmic sperm injection in women with previous unilateral oophorectomy: a systematic review and meta-analysis. Fertil Steril 2022; 117:992-1002. [PMID: 35277262 DOI: 10.1016/j.fertnstert.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To quantify the effect of unilateral oophorectomy (UO) on the rates of live birth and pregnancy in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). DESIGN Systematic review and meta-analysis. SETTING Search of databases of published articles. PATIENT(S) The final analytical cohort encompassed 1,057 IVF/ICSI cycles in women with previous UO and 45,813 IVF/ICSI cycles in control women. Eighteen studies were identified by database searches of MEDLINE, Embase, Web of Science, and cited references. The review encompassed studies published up to June 1, 2021. INTERVENTION(S) UO prior to IVF/ICSI. MAIN OUTCOME MEASURE(S) The primary outcomes were the rates of live birth and pregnancy following IVF/ICSI. The secondary outcomes included the amount of gonadotropins administered for ovarian stimulation and the number of retrieved oocytes. RESULT(S) The studies were rated from medium to high quality (from 5 to 8) according to the Newcastle-Ottawa Quality Assessment Scale. All studies were observational, with inherent bias, and heterogeneity was high. The primary outcome of live birth had a significantly lower odds ratio (OR) in women with previous UO compared with controls (OR = 0.72, 95% confidence interval [CI] 0.57 to 0.91, z = -2.72). The OR for pregnancy rate per initiated treatment cycle was also significantly lower in women with previous UO compared with controls (OR = 0.70, 95% CI 0.57 to 0.86, z = -3.35). Additionally, the dose of administered gonadotropins was significantly higher and the number of retrieved oocytes was significantly lower in women with UO. CONCLUSION(S) The meta-analysis showed a significant detrimental effect of UO on the rates of live birth and pregnancy. The analysis further supports previous data showing a decreased sensitivity to gonadotropins and a lower number of recovered oocytes in women with previous UO. STUDY REGISTRATION NUMBER PROSPERO 2020, CRD42020160313.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynaecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden.
| | - Hanna P Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tekla Lind
- Department of Obstetrics and Gynaecology, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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9
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Silber SJ, Goldsmith S, Castleman L, Hurlbut K, Fan Y, Melnick J, Hayashi K. In-vitro maturation and transplantation of cryopreserved ovary tissue: understanding ovarian longevity. Reprod Biomed Online 2022; 44:504-514. [PMID: 35151573 DOI: 10.1016/j.rbmo.2021.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
RESEARCH QUESTION Is it possible to use experience gained from 24 years of frozen ovarian transplantation, and from recent experience with in-vitro gametogenesis to accomplish simple and robust in-vitro maturation (IVM) of oocytes from human ovarian tissue? DESIGN A total of 119 female patients between age 2 and 35 years old underwent ovary cryopreservation (as well as in-vitro maturation of oocytes and IVM in the last 13 individuals) over a 24-year period. Up to 22 years later, 17 returned to have their ovary tissue thawed and transplanted back. RESULTS Every woman had a return of ovarian function 5 months after transplant, similar to previous observations. As observed before, anti-Müllerian hormone (AMH) concentration rose as FSH fell 4 months later. The grafts continued to work up to 8 years. Of the 17, 13 (76%) became pregnant with intercourse at least once, resulting in 19 healthy live births, including six live births from three women who had had leukaemia. Of the harvested germinal vesicle oocytes, 35% developed with simple culture media into mature metaphase II oocytes. CONCLUSIONS The authors concluded the following. First, ovary tissue cryopreservation is a robust method for preserving fertility even for women with leukaemia, without a need to delay cancer treatment. Second, many mature oocytes can often be obtained from ovary tissue with simple media and no need for ovarian stimulation. Third, ovarian stimulation only be necessary for removing the oocyte from the ovary, which can also be accomplished by simple dissection at the time of ovary freezing. Finally, pressure and just eight 'core genes' control primordial follicle recruitment and development.
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Affiliation(s)
| | | | | | | | - Yuting Fan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor MI, USA
| | | | - Katsuhiko Hayashi
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku Fukuoka, Japan
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Karavadara D, Davidson JR, Story L, Diab Y, Upadhyaya M. Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre. Pediatr Surg Int 2021; 37:1281-1286. [PMID: 34235545 PMCID: PMC8325645 DOI: 10.1007/s00383-021-04935-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aetiology and management of ovarian pathology in children differs between antenatal and postnatal lesions. However, all lesions may present acutely due to adnexal torsion. In this setting, opportunities to preserve fertility with ovary-sparing surgery (OSS) may be missed. Some studies suggest that pediatric and adolescent gynaecology (PAG) input in care is associated with OSS. METHODS A retrospective cohort study of children undergoing surgery for ovarian pathology at a tertiary pediatric surgery centre over an 8-year period (2011-2018). Patient factors, lesion characteristics and PAG involvement were examined for association with OSS using multivariate logistic regression. RESULTS Thirty-five patients with ovarian pathology managed surgically were included. Ten were infants with lesions detected antenatally; all were managed by pediatric surgeons (PS) alone at median age 2 weeks (1 day-25 weeks). Twenty-five patients presented postnatally at median age 11 (0.75-15) years. In total, there were 16 cases of adnexal torsion, each managed primarily by PS. Twelve underwent oophorectomy and six (50%) of these cases had viable ovarian tissue on histology. Furthermore, two infants with large simple cysts were similarly managed by unnecessary oophorectomy based on histology. Overall rate of OSS was 46% and PAG involvement was the only factor associated with ovarian salvage. CONCLUSION Differences in surgical management between PAGs and PS may be attributable to the different patient populations they serve. We recommend improving the knowledge of PS trainees in OSS approaches for adnexal torsion and large benign lesions.
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Affiliation(s)
- D Karavadara
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK
- King's College London School of Medicine, London, UK
| | - J R Davidson
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- Stem Cells and Regenerative Medicine, GOS-UCL Institute of Child Health, London, UK.
- Prenatal Cell and Gene Therapy, EGA-UCL Institute for Women's Health, London, UK.
| | - L Story
- King's College London School of Medicine, London, UK
- Department of Obstetrics, Gynaecology and Maternal-Fetal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Y Diab
- Department of Obstetrics, Gynaecology and Maternal-Fetal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Upadhyaya
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- King's College London School of Medicine, London, UK.
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11
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Prognostication of Ovarian Function after Ovarian Torsion Using Intraoperative Indocyanine Green Angiography. J Minim Invasive Gynecol 2021; 29:237-242. [PMID: 34375741 DOI: 10.1016/j.jmig.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To quantitatively evaluate the blood flow in ovaries (ischemic ovaries) that underwent torsion using indocyanine green angiography (ICGA) and assess the use of ICGA as an indicator for functional preservation of the ovaries. DESIGN In vivo animal study. SETTING The University of Yamanashi Animal Experimentation Center. SUBJECTS Eighteen female Wistar albino rats. INTERVENTIONS As an alternative to ovarian torsion, we occluded an ovary in each rat for 24 hours, after which we performed ICGA before and after releasing ischemia and extracted the following 8 parameters: Fmax (maximum F value before releasing ischemia); Tmax (time taken from the onset of an increase in F to reaching Fmax); T½max (time taken from the onset of an increase in F to reaching half of Fmax); slope (Fmax/Tmax); time ratio (T½max/Tmax); F'max (maximum F value after releasing ischemia); reperfusion rate (F'max/Fmax); and reperfusion gap (F'max - Fmax). Four weeks later, we counted the total number of primordial and primary follicles and classified the rats into functional and nonfunctional groups. MEASUREMENTS AND MAIN RESULTS On the basis of the total number of primordial and primary follicles, 13 rats had "functional" ovaries on the clamped side, and 5 rats had "nonfunctional" ovaries. The area under the curve values for each parameter were as follows: Fmax, 0.908; Tmax, 0.569; T½max, 0.546; time ratio, 0.746; slope, 0.877; F'max, 0.723; reperfusion rate, 0.938; and reperfusion gap, 0.862. CONCLUSION ICGA can be used to quantitatively evaluate ovaries that have been subjected to ischemia, and the magnitude of fluorescence intensity can be an excellent predictor of ovarian necrosis. Quantifying the degree of reperfusion immediately after the release of ischemia can be an equally excellent predictor of necrosis.
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12
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Aljahdali GL, Alkhaldi FA, Almujarri SF, Alsadhan HF, Yaqoub AS, Alsahabi JA, Masud N, Felemban AA. Live Birth Rate Comparison Between Single vs. Double Ovary Women With Assisted Reproduction: A Single Tertiary Center Study. Cureus 2021; 13:e14876. [PMID: 34104604 PMCID: PMC8179779 DOI: 10.7759/cureus.14876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction
One of the major hardships faced by married couples is the inability to conceive a child. This issue is becoming more prevalent given the increasing rate of infertility worldwide. Assisted reproductive technology (ART) has brought hope to infertile couples. We aim to estimate the live birth rate (LBR) and pregnancy rate in women with one ovary compared with those with two ovaries. Methods A retrospective cohort study of women who underwent ART at King Abdulaziz Medical City (Jan 2000 - Dec 2018) was conducted. Five cycles of patient data were collected. The LBR (both conditional and cumulative) was compared between women with one and two ovaries. Results The final analysis included 403 women. Of these, 9% (n = 37) had one ovary. The majority (59%, n = 233) had primary infertility. A male-associated factor accounted for 52% (n = 208) of the infertility cases. The total number of live births was 164; and the overall LBR from five cycles was estimated as 9%, 16%, 18%, 18%, and 15%, respectively. In the double ovary group, the highest rate was in the fourth cycle [19% (12-26)], while in the single ovary group peaked in the third cycle [27% (9-46)]. Pregnancy was at its highest in the first cycle, accounting for 88 pregnancies. Conclusion The outcomes of ART varied between study groups. LBR was lower in single ovary women. The average of five cycles in the single and double ovary groups was 13% and 15%, respectively. Nevertheless, there was no significant difference in LBR between single or double ovary women.
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Affiliation(s)
- Ghadeer L Aljahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Fatimah A Alkhaldi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Sarah F Almujarri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Haifa F Alsadhan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Amirah S Yaqoub
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Jawaher A Alsahabi
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Nazish Masud
- Research Unit, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Afaf A Felemban
- Department of In-Vitro Fertilization, King Abdulaziz Medical City, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
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13
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Vesztergom D, Segers I, Mostinckx L, Blockeel C, De Vos M. Live births after in vitro maturation of oocytes in women who had suffered adnexal torsion and unilateral oophorectomy following conventional ovarian stimulation. J Assist Reprod Genet 2021; 38:1323-1329. [PMID: 33826051 DOI: 10.1007/s10815-021-02171-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the first successful application of in vitro maturation (IVM) of oocytes resulting in live births in two anovulatory women who had suffered oophorectomy following ovarian torsion after stimulation with gonadotropins. METHODS Data abstraction was performed from medical records of two subfertile women with excessive functional ovarian reserve. Both women had previously received gonadotropins for ovulation induction or ovarian stimulation, resulting in ovarian torsion. They were offered IVM of oocytes retrieved from antral follicles after mild ovarian stimulation, insemination of mature oocytes using ICSI, and embryo transfer. Outcome measures were the incidence of complications and live birth after fertility treatment. RESULTS Transvaginal retrieval of cumulus-oocyte complexes from a unique ovary was conducted. One patient had a singleton live birth after vitrified-warmed embryo transfer in the second IVM cycle. The other patient had a singleton live birth after transfer of a fresh blastocyst in her first IVM cycle. CONCLUSIONS Although approaches have been developed to prevent ovarian hyperstimulation syndrome (OHSS) and to increase the safety profile of fertility treatment in predicted high responders, women with an excessive functional ovarian reserve may have a non-negligible risk of ovarian torsion. For these patients, IVM should be considered as a safer alternative approach.
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Affiliation(s)
- Dóra Vesztergom
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 109, Brussels, Belgium
- Centre for Assisted Reproduction, Clinic of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Ingrid Segers
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 109, Brussels, Belgium
| | - Linde Mostinckx
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 109, Brussels, Belgium
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 109, Brussels, Belgium
- Department of Obstetrics and Gynaecology, University of Zagreb-School of Medicine, Zagreb, Croatia
| | - Michel De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 109, Brussels, Belgium.
- Follicle Biology Laboratory (FOBI), UZ Brussel, Vrije Universiteit Brussel (VUB), 1090, Brussels, Belgium.
- Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia.
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14
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Gasparri ML, Ruscito I, Braicu EI, Sehouli J, Tramontano L, Costanzi F, De Marco MP, Mueller MD, Papadia A, Caserta D, Bellati F. Biological Impact of Unilateral Oophorectomy: Does the Number of Ovaries Really Matter? Geburtshilfe Frauenheilkd 2020; 81:331-338. [PMID: 33692594 PMCID: PMC7938940 DOI: 10.1055/a-1239-3958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022] Open
Abstract
Although unilateral oophorectomies are performed more often than bilateral ones in women of reproductive age, their clinical consequences have been less intensively investigated. Experimental models in animals have shown that compensatory mechanisms occur after a unilateral oophorectomy (UO). This review aims to summarize the available evidence on the biological effects of unilateral oophorectomy on women. Evaluated outcomes include age at onset of menopause, risk of cardiovascular and neurological disease, risk of mortality and fertility outcome after spontaneous conception or in vitro fertilization (IVF). Results were compared with findings reported after bilateral oophorectomy and/or ovarian excision and/or women with intact ovaries. An electronic database search was performed using PubMed and Scopus, followed by a manual search to identify controlled studies that compared women after UO with women with two intact ovaries. In particular, a systematic review of
fertility outcomes after IVF was performed, and the data were summarized in a table. Women who underwent UO had a similar age at menopause and similar clinical pregnancy rate compared to women with two ovaries. However, decreased ovarian reserve affecting the quantity but not the quality of the ovarian pool after IVF was observed in the UO group. Furthermore, an increased risk of neurological disease and even an increased risk of mortality was observed in women with single ovary. These data need to be confirmed by further studies, and a plausible mechanism of action must be identified. At present, patients who undergo UO can be reassured with regard to their reproductive potential and their age at onset of menopause.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Università Svizzera Italiana, Lugano, Switzerland
| | - Ilary Ruscito
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.,Department of Gynaecology, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Ioana Braicu
- Department of Gynaecology, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynaecology, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luca Tramontano
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Università Svizzera Italiana, Lugano, Switzerland
| | - Flavia Costanzi
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Paola De Marco
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Università Svizzera Italiana, Lugano, Switzerland
| | - Donatella Caserta
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Filippo Bellati
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
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15
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Endometriosis and cumulative live birth rate after fresh and frozen IVF cycles with single embryo transfer in young women: no impact beyond reduced ovarian sensitivity-a case control study. J Assist Reprod Genet 2019; 36:1649-1656. [PMID: 31313013 PMCID: PMC6707971 DOI: 10.1007/s10815-019-01519-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/02/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose To investigate the impact of symptomatic and surgically confirmed endometriosis on ovarian sensitivity index (OSI) and cumulative live-birth rates (LBR) using predominantly single embryo transfer (SET). Methods Cross-sectional case-control study in a University-based ART program. Women with symptomatic and surgically confirmed endometriosis (N = 172), who underwent IVF/ICSI at Karolinska University Hospital were compared to controls without clinically suspected endometriosis (N = 2585). Two thousand seven hundred fifty-seven patients underwent 8236 treatment cycles (4598 fresh and 3638 frozen cycles). Primary outcome measures included Ovarian Sensitivity Index (OSI) estimated as collected oocytes/FSH dose and cumulative LBR/oocyte pickup (OPU). Generalized estimated equation (GEE) model accounting for dependencies between consecutive treatments were applied. Secondary outcomes included number of oocytes, pregnancy rate per OPU and per ET, LBR per ET, and miscarriage rate. Results Patients diagnosed with endometriosis had significantly fewer oocytes collected (8.47 vs. 9.54, p = 0.015) and lower OSI (p = 0.011) than controls. There were no differences in cycle cancelations (p = 0.59) or miscarriages (p = 0.95) between the two groups. Cumulative LBR/OPU did not differ between women with endometriosis and controls (35.6% vs. 34.7%, respectively, p = 0.83). In both groups, more than 60% of women had consecutive FETs after fresh ETs (p = 0.49) with SET in > 70% of cases. The results were similar whether ovarian endometrioma was present or not. Conclusions Our data support that a diagnosis of endometriosis, with or without present endometrioma, does not negatively affect ART cumulative results. The impact of endometriosis was discernible on OSI but not on clinical relevant outcomes including pregnancy and LBR.
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16
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Abstract
PURPOSE OF REVIEW This review highlights progress in the management of pediatric ovarian neoplasms. Recent research has identified disparities in the management of patients with benign ovarian neoplasms based on a variety of factors. However, the long-term effects of unilateral oophorectomy have prompted an emphasis on ovary-sparing surgery (OSS) for benign masses. One of the challenges still facing providers is the preoperative differentiation between benign and malignant masses. RECENT FINDINGS Recent studies highlight the variability in practice patterns surrounding the management of benign ovarian neoplasms. Progress continues to be made in identifying reliable factors that can be used to inform preoperative risk stratification of patients who present with ovarian neoplasms. These factors include imaging characteristics, symptoms and tumor markers. In addition, the safety of OSS with regard to recurrence and upstaging in appropriate settings continues to be demonstrated. SUMMARY This review highlights the importance of multidisciplinary collaboration in the treatment of ovarian neoplasms given the varied surgical approach by specialty. Multiple retrospective studies have identified factors that can be used for preoperative risk stratification and selection of patients for OSS. Prospective studies evaluating the accuracy of these factors for preoperative risk stratification are needed.
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17
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Silber SJ, DeRosa M, Goldsmith S, Fan Y, Castleman L, Melnick J. Cryopreservation and transplantation of ovarian tissue: results from one center in the USA. J Assist Reprod Genet 2018; 35:2205-2213. [PMID: 30255455 PMCID: PMC6289920 DOI: 10.1007/s10815-018-1315-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the results of cryopreserved ovary tissue transplantation for leukemia and other cancers, in a single US center. Methods One hundred eight females between age 6 and (median age 24) 35 were referred for possible ovary tissue cryopreservation over a 20-year period, with either slow freeze or vitrification. Thus far 13 patients returned up to 18 years later to have their tissue transplanted back. Results All 13 patients had return of ovarian function 5 months post transplant with regular menstrual cycling. AMH rose to very high levels as the FSH declined to normal. Four months later, the AMH again declined to very low levels. Nonetheless, the grafts remained functional for up to 5 years or longer. Ten of the 13 (77%) became spontaneously pregnant at least once, resulting in 13 healthy babies. A total of 24 healthy babies have been born 11 from fresh transplanted ovarian tissue and 13 from cryopreserved transplanted ovarian tissue. Conclusions (1) Ovary tissue cryopreservation is a robust method for preserving a woman’s fertility. (2) Cortical tissue pressure may be a key regulator of primordial follicle arrest, recruitment, and ovarian longevity. (3) This is the only such series yet reported in the USA.
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Affiliation(s)
- Sherman J Silber
- Infertility Center of St. Louis, 224 South Woods Mill Road, Saint Louis, MO, 63017, USA.
| | - Michael DeRosa
- Infertility Center of St. Louis, 224 South Woods Mill Road, Saint Louis, MO, 63017, USA
| | - Sierra Goldsmith
- Infertility Center of St. Louis, 224 South Woods Mill Road, Saint Louis, MO, 63017, USA
| | - Yuting Fan
- Whitehead Institute, Massachusetts Institute of Technology, Cambridge, MA, USA.,Sun Yat-sen University of Medical Sciences, Guangzhou, Guangdong, China
| | - Leilani Castleman
- Infertility Center of St. Louis, 224 South Woods Mill Road, Saint Louis, MO, 63017, USA
| | - Jeffrey Melnick
- St. Luke's Hospital Pathology, 232 South Woods Mill Road, St. Louis, MO, 63017, USA
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