Uterine transposition: technique and a case report

Ribeiro, Reitan; Rebolho, Juliano Camargo; Tsumanuma, Fernanda Keiko; Brandalize, Giovana Gugelmin; Trippia, Carlos Henrique; Saab, Karam Abou

doi:10.1016/j.fertnstert.2017.06.016

Cited by 48 publications

(34 citation statements)

References 24 publications

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“…Improved anti-cancer regimes have significantly increased survival rates among cancer patients and it is therefore important to consider fertility after treatment and other quality-of-life factors. Options for fertility preservation in female cancer patients include ovarian/uterus transposition, embryo/oocyte vitrification or ovarian cortex cryopreservation [ 3 – 6 ]. In many cases, ovarian cortex transplantation can successfully restore fertility for female cancer survivors [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Decellularization and recellularization of the ovary for bioengineering applications; studies in the mouse

Alshaikh

Padma

Dehlin

et al. 2020

Reprod Biol Endocrinol

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Background Fertility preservation is particularly challenging in young women diagnosed with hematopoietic cancers, as transplantation of cryopreserved ovarian cortex in these women carries the risk for re-introducing cancer cells. Therefore, the construction of a bioengineered ovary that can accommodate isolated small follicles was proposed as an alternative to minimize the risk of malignancy transmission. Various options for viable bioengineered scaffolds have been reported in the literature. Previously, we reported three protocols for producing mouse ovarian scaffolds with the decellularization technique. The present study examined these scaffolds further, specifically with regards to their extracellular composition, biocompatibility and ability to support recellularization with mesenchymal stem cells. Material and methods Three decellularization protocols based on 0.5% sodium dodecyl sulfate (Protocol 1; P1), or 2% sodium deoxycholate (P2), or a combination of the two detergents (P3) were applied to produce three types of scaffolds. The levels of collagen, elastin and sulfated glycosaminoglycans (sGAGs) were quantified in the remaining extracellular matrix. Detailed immunofluorescence and scanning electron microscopy imaging were conducted to assess the morphology and recellularization efficiency of the constructs after 14 days in vitro utilizing red fluorescent protein-labelled mesenchymal stem cells. Results All protocols efficiently removed the DNA while the elastin content was not significantly reduced during the procedures. The SDS-protocol (P1) reduced the sGAG and the collagen content more than the SDC-protocol (P2). All scaffolds were biocompatible and recellularization was successful, particularly in several P2-derived scaffolds. The cells were extensively distributed throughout the constructs, with a denser distribution observed towards the ovarian cortex. The cell density was not significantly different (400 to 550 cells/mm 2 ) between scaffold types. However, there was a tendency towards a higher cell density in the SDC-derived constructs. Scanning electron microscope images showed fibrous scaffolds with a dense repopulated surface structure. Conclusions While there were differences in the key structural macromolecules between protocols, all scaffolds were biocompatible and showed effective recellularization. The results indicate that our SDC-protocol might be better than our SDS-protocol. However, additional studies are necessary to determine their suitability for attachment of small follicles and folliculogenesis.

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Section: Introductionmentioning

confidence: 99%

Decellularization and recellularization of the ovary for bioengineering applications; studies in the mouse

Alshaikh

Padma

Dehlin

et al. 2020

Reprod Biol Endocrinol

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“…Prior to AP RT treatment, uterine transposition is the only fertility preserving option (apart from the radiation techniques such as shielding). This is experimental, with few case reports in the literature and no successful pregnancies to date ( Ribeiro et al , 2017 ; Ribeiro et al , 2019 ). For carcinoma of the cervix treated with chemoradiation, there is no possibility of pregnancy with the patient’s own uterus and existing options for having a baby include surrogacy or adoption.…”

Section: Introductionmentioning

confidence: 99%

Clinical summary guide: reproduction in women with previous abdominopelvic radiotherapy or total body irradiation

Rozen

Rogers

Chander

et al. 2020

Human Reproduction Open

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STUDY QUESTION What is the evidence to guide the management of women who wish to conceive following abdominopelvic radiotherapy (AP RT) or total body irradiation (TBI)? SUMMARY ANSWER Pregnancy is possible, even following higher doses of post-pubertal uterine radiation exposure; however, it is associated with adverse reproductive sequelae and pregnancies must be managed in a high-risk obstetric unit. WHAT IS KNOWN ALREADY In addition to primary ovarian insufficiency, female survivors who are treated with AP RT and TBI are at risk of damage to the uterus. This may impact on its function and manifest as adverse reproductive sequelae. STUDY DESIGN, SIZE, DURATION A review of the literature was carried out and a multidisciplinary working group provided expert opinion regarding assessment of the uterus and obstetric management. PARTICIPANTS/MATERIALS, SETTING, METHODS Reproductive outcomes for postpubertal women with uterine radiation exposure in the form of AP RT or TBI were reviewed. This included Pubmed listed peer-reviewed publications from 1990 to 2019, and limited to English language.. MAIN RESULTS AND THE ROLE OF CHANCE The prepubertal uterus is much more vulnerable to the effects of radiation than after puberty. Almost all available information about the impact of radiation on the uterus comes from studies of radiation exposure during childhood or adolescence. An uncomplicated pregnancy is possible, even with doses as high as 54 Gy. Therefore, tumour treatment doses alone cannot at present be used to accurately predict uterine damage. LIMITATIONS, REASONS FOR CAUTION Much of the data cannot be readily extrapolated to adult women who have had uterine radiation and the publications concerning adult women treated with AP RT are largely limited to case reports. WIDER IMPLICATIONS OF THE FINDINGS This analysis offers clinical guidance and assists with patient counselling. It is important to include patients who have undergone AP RT or TBI in prospective studies to provide further evidence regarding uterine function, pregnancy outcomes and correlation of imaging with clinical outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study received no funding and there are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

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“…Uterine fixation was reported in 2017 in Brazil in a 26 year old woman with rectal adenocarcinoma to limit uterine damage from pelvic radiation [24]. Pelvic radiation results in uterine fibrosis, vascular and endometrial damage that may prevent a woman from carrying a pregnancy [25]; often, a gestational carrier is required.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Pelvic radiation results in uterine fibrosis, vascular and endometrial damage that may prevent a woman from carrying a pregnancy [25]; often, a gestational carrier is required. Uterine fixation involves transection of the round ligament at the pelvic sidewall, dissection of the vesicouterine space to 1 cm distal to the cervicovaginal junction, coagulation of uterine vessels, amputation of the uterus from the vagina along a colpotomy ring, and dissection of the infundibulopelvic ligaments to the iliac vessels leaving a completely mobilized uterus that is repositioned into the upper abdomen with round ligaments sutured to the anterior abdominal wall and cervix anastomosed to umbilical fascia (outlet for menses) [24]. A newer, simpler technique has emerged, also in a young woman with rectal adenocarcinoma; in this case, the uterus was attached to anterior abdominal wall fascia (as cranial as possible) using 3 sutures at time of laparoscopic ovarian transposition [26].…”

Section: Surgical Techniquesmentioning

confidence: 99%

An update on fertility preservation strategies for women with cancer

Campbell

Woodard

2020

Gynecologic Oncology

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Uterine transposition: technique and a case report

Abstract: Uterine transposition might represent a valid option for fertility preservation in women who require pelvic radiotherapy and want to bear children. However, studies that assess its viability, effectiveness, and safety are required.

Cited by 48 publications

References 24 publications

Decellularization and recellularization of the ovary for bioengineering applications; studies in the mouse

Decellularization and recellularization of the ovary for bioengineering applications; studies in the mouse

Clinical summary guide: reproduction in women with previous abdominopelvic radiotherapy or total body irradiation

An update on fertility preservation strategies for women with cancer

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