Transplantation of female genital organs

Abstract

Transplantation of gynecological organs is a medical field where considerable advancements have been made in research during the last 25 years and with some procedures already introduced as clinical treatments. These types of transplantations aim at curing permanent infertility. Uterus transplantation has been proven to be a feasible procedure in different experimentation animal models with proof of concept concerning surgery, control of rejection and fertility. There has already been one human transplantation attempt, which, however, was unsuccessful. Based on the progress in this area, we predict that the first successful uterus transplantation attempt will come within 2-3 years. Orthotopic ovarian cortex transplantation has overcome the status of an experimental procedure since more than 20 pregnancies have been reported. Its main field of application is fertility preservation in oncologic patients undergoing high gonadotoxic risk therapies. The role of heterotopic ovarian cortex transplantation still remains at the research level, although co-transplantation with an orthotopic cortex might facilitate a more accurate endocrine environment. The major drawback of ovarian cortex transplantation remains the long ischemic interval between re-implantation and the establishment of neovascularization. Whole ovary cryopreservation followed by transplantation through vascular anastomosis may emerge as an important procedure in this field, because the warm ischemic time would be reduced from several days to less than 1 h, which will most likely improve follicle survival. In summary, transplantation surgery is also entering the field of gynecology and in the future several types of transplantations of organs/tissues of the female reproductive tract may become established clinical procedures.

The effect of warm ischemia at uterus transplantation in a rat model

“…in the human. Remarkable advances have been achieved in the field of UTx during the last decade (6).…”

“…Although a necrotic uterus was removed 99 days after surgery (5), this human patient motivated researchers to develop the UTx field towards establishing UTx as a feasible and safe procedure to be applied in the human. Remarkable advances have been achieved in the field of UTx during the last decade (6).…”

Developmental Status: Impact of Short-Term Ischemia on Follicular Survival of Whole Ovarian Transplantation in a Rabbit Model

“…Whole ovarian transplantation represents an exciting new technique that can improve follicular pool maintenance and avoid follicle depletion. Compared to ovarian cortex transplantation, whole ovary transplantation through vascular anastomosis would reduce the warm ischemic time, which will most likely improve follicle survival [ 5 , 6 ]. The first report of a successful transplantation with follicle development in humans was in the year 2008, in a patient who had complete orthotopic grafting of fresh whole ovaries to treat Turner’s syndrome[ 7 ].…”

Effects of culture and transplantation on follicle activation and early follicular growth in neonatal mouse ovaries

“…Ovarian tissue transplantation is another noteworthy procedure that is used for follicular maturation. Orthotopic and heterotopic transplantation of fresh/cryopreserved whole ovaries/ovarian cortices has been performed in various animal species (Brannstrom and Diaz-Garcia 2011 ). The main application of this surgical technique is to develop human ovarian tissue, with the aim of to re-establishing fertility in cancer patients after fertility-threatening treatments (Smitz et al 2010 ).…”