First
described in 1958, ovarian transposition is a great way to move ovaries away
from the radiation field to preserve fertility and prevent early menopause in
reproductive age women undergoing pelvic or low abdominal radiation therapy.
These women may also be scheduled to receive chemotherapy, which has low gonadotoxicity after
the radiation therapy.
The vascular
pedicle remains intact in transposition vs. transplantation. Ovarian
stimulation and oocyte retrieval can be easily performed later when the patient
desires fertility.
Oocytes are
highly sensitive to radiation and 16 gray (Gy) of radiation will deplete the
entire oocyte pool in a 20-year-old.
The most
common cancers which require low abdominal radiations are rectal and anal
cancers.
A recent article
published in forthcoming issue of Fertility and Sterility describes and
demonstrate novel surgical method of laparoscopic ovarian transposition. This
is a minimal invasive approach in which the ovary is tunneled through a
peritoneum.
A 29-year-old
female was diagnosed with rectal cancer, the patient underwent laparoscopic
ovarian transposition of one ovary followed by ovarian decortication for
ovarian tissue freezing of the contralateral ovary, both performed in one
laparoscopic surgery, before further chemotherapy and radiation.
The procedure
was performed to maintain the ovarian blood supply retroperitoneally and prevent
the ovarian vessels taking a sharp turn in pelvic cavity.
The laparoscopic
ovarian transposition has a success rate of 88.6% for preservation of ovarian
function as seen from the levels of gonadotropin levels after cancer treatment.
A systematic
review and meta-analysis of published in Journal of Ovarian Research concluded
that it significantly preserves ovarian function with minimum risk of
metastasis to the ovary even in gynecological malignancies.
Here is the
video presentation of the surgical procedure by Cleveland Clinics.
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