Ovarian Transplantation Between Monozygotic Twins Discordant for Premature Ovarian Failure

Abstract

From January 1998 through August, 2001, 108 women with a preoperative diagnosis of suspected ovarian dermoid cyst underwent surgical treatment at the University of Miami. Fifty-three patients underwent laparoscopic cystectomy (n ϭ 32, 61%) or laparoscopic oophorectomy (n ϭ 21, 39%) and another 55 patients had laparotomy for ovarian cystectomy or oophorectomy.Laparoscopy was performed using three or four trocars, at least one of which was placed at the umbilicus. During laparoscopic cystectomy, after separation from the ovary, the cyst was placed into an impermeable bag. The bag was removed using the largest trocar port. When the opening of the bag was completely out of the port, the contents of the cysts were drained in the bag before complete removal. If spillage occurred, lavage of the peritoneal cavity was performed until the irrigation was clear.The mean age of patients was significantly lower (27.6 years; range, 7-46 years) for the 55 women who underwent laparotomy compared with those who had laparoscopy (33.5 years; range, 19-55 years) (P Ͻ0.001). Otherwise, the two groups were comparable. Chronic pain was the most common presenting complaint (69%). Four patients presented with acute pelvic pain and 22% of patients had no symptoms. Nearly one third of patients had more than one presenting symptom.Dermoid cysts tended to be larger in women who had laparotomy (mean cyst diameter 9.75 cm) compared with the women who underwent laparoscopy (mean cyst diameter 6.52 cm) (P ϭ 0.007). Fourteen percent of the patients had bilateral cysts. Spillage of the cyst contents was much more frequent in women who underwent laparoscopy (31.4%) compared with those who had laparotomy (4.1%) (P ϭ 0.0004). The mean operating room time was significantly less for laparotomy procedures than for laparoscopy (88 minutes vs 118 minutes) (P ϭ 0.0008), but mean blood loss was greater in laparotomy procedures compared with laparoscopy (119 mL and 72 mL, respectively; P ϭ 0.002).Intraoperative laparoscopy complications included uterine perforation in two women, enterotomy in one patient, and cystotomy in one laparotomy patient. There were more postoperative complications in laparotomy patients (n ϭ 8) than in the laparoscopic group (n ϭ 2). In the laparoscopic group, one patient had a postoperative wound infection and one woman developed a hernia. Among laparotomy patients, there were four postoperative wound infections, one urinary tract infection, two postoperative fevers, and one death. The woman who died was obese with a 24-cm partially infracted dermoid cyst and died the day after surgery of cardiac arrhythmia. Nine (17%) patients undergoing laparoscopy were converted to laparotomy, four because of the large size of the mass and five as a result of adhesions. Nine patients with pain and cyst torsion underwent laparotomy.Laparoscopy was significantly more commonly associated with dermoid cyst spillage, even when adjustments were made for cyst size, oophorectomy, and cystectomy. No patient in this series developed peritonitis. EDITORIAL C...

Activation of dormant ovarian follicles to generate mature eggs

“…Likewise, only few human antral follicles developed from primordial follicles after xeno-transplantation into immune-deficient mice (32). One case of successful ovarian transplantation between monozygotic twins discordant for premature ovarian failure has been reported, and the patient delivered a healthy baby (33). In addition, ovarian auto-transplantation to the forearm has been successfully performed in women undergoing sterilizing cancer therapy, but less than a dozen pregnancies have been reported (34).…”

Optimizing cryoprotectant perfusion conditions for intact ovary: a bovine model

“…Thus far, five reports have described fresh whole ovary grafts with vascular anastomosis in human, and one successful pregnancy was recorded [14,[27][28][29][30][31]. In the past few years, attempts at freezing and grafting whole ovaries in animal have yielded encouraging results.…”

Role of Smart Medium Supplemented With Follicular Fluid in in Vitro Maturation for Sheep Immature Oocytes Recovered From Xenotransplanted Ovarian Tissue Cortex.

“…It was known that atretic follicles may reflect the pre-existing atretic changes instead of the effect of (OTT) (28) . Also, it was certified that an important technical limitation of cortical grafting, whether orthotopic or heterotopic, is the potential for follicle atresia during the period of ischemia (29) . Furthermore, presence of atretic and/or abnormal oocytes, in the present study, may be reflecting wide range of fluctuation of gonadotropins and/or inadequate exposure to gonadotropins which led to abnormal follicular development and subsequently produce abnormal and atretic oocytes.…”