Reestablecimiento de la función endocrina de implantes ováricos heterotópicos no pediculizados

Francisco Cóppola; Jorge Martínez Torena; Álvaro Domínguez; Sara Parada; Héctor Pérez Campos; Yashmin Afonzo; Liliana de Dios; Rafael Aguirre

Authors

Francisco Cóppola Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica "C", Prof. Adj. Endocrinólogo y Ginecotocólogo
Jorge Martínez Torena Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica "C", Prof. Agdo. Cirugía Ginecológica Oncológica, Encargado. Ginecotocólogo
Álvaro Domínguez Ginecotocólogo. Especialista en Reproducción Humana
Sara Parada Centro Hospitalario Pereira Rossell, Unidad de Ecografía Ginecológica, Médico Ecografista
Héctor Pérez Campos Uruguay, Banco Nacional de Órganos y Trasplantes, Laboratorio de Criobiología, Director
Yashmin Afonzo Centro Hospitalario Pereira Rossell, Centro de Hematooncología Pediátrica, Especialista en Oncología Pediátrica
Liliana de Dios Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica "C", Residente
Rafael Aguirre Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica "C", Programa Educación Médica Continua, Coordinador Docente. Ginecotocólogo

Keywords:

AUTOLOGOUS TRANSPLANT, HETEROTOPIC TRANSPLANTATION, OVARIES, PELVIS

Abstract

Background: the study shows the results of heterotopic ovarian transplant as an alternative to reestablish ovarian function for women who should undergo pelvic and abdominal radiotherapy. Evolution of three women, two carriers of cervical cancer and one carrier of sacral ependymoma with neurological manifestations is showed. In order to protect against gonadotixicity of pelvic radiotherapy, women underwent bilateral oophorectomy and subcutaneous heterotopic ovarian autotransplants. In two of them, ovarian tissue was cryopreserved.
Methods: the protocol Preservation of the ovarian function Program was used. The protocol was carried out by the Faculty of Medicine (Universidad de la República Oriental del Uruguay) and the Ministry of Public Health of Uruguay.
Results: all patients showed revascularization of the transplanted tissue, hormonal function recovery and ovarian follicular growth. These three observations are now added to international literature.
Conclusions: recovery of ovarian endocrine function, better quality of life (climacteric syndrome relief) and ovarian follicular growth were proved. The development of this technique may offer an alternative for women who undergo radiotherapy and ovarian failure consequences are expected.

References

(1) Sutton G, Bundy B, Delgado G, Sevin B, Creasman W, Major F, et al. Ovarian metastases in stage IB carcinoma of the cervix: a Gyneacologic Oncology Group Study. Am J Obstet Gynecol 1992; 166 (1Pt1): 50-3.
(2) Wu HS, Yen MS, Lai CR, Ng HT. Ovarian metastasis from cervical carcinoma. Int J Gynaecol Obstet 1997; 57(2): 173-8.
(3) Wallace W, Thomson A, Saran F, Kelsey T. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys 2005; 62(3): 738-44.
(4) Wallace W, Thomson A, Kelsey T. The radiosensitivity of the human oocyte. Hum Reprod 2003; 18(1): 117-21.
(5) Buekers TE, Anderson B, Sorosky JL, Buller RE. Ovarian function after surgical treatment of cancer. Gynecol Oncol 2001; 80: 85-8.
(6) Anderson B, LaPolla J, Turner D, Chapman G, Buller R. Ovarian transposition in cervical cancer. Gynecol Oncol 1993; 49(2): 206-14.
(7) Hilders CG, Baransky AG, Peters L, Ramkhelawan A, Trimbos JB. Susccessful human auto-transplantation to the upper arm. Cancer 2004; 101(12): 2771-8.
(8) Leporrier M, Von Theolbald P, Roffe JL, Muller G. A new technique to protect ovarian function before pelvic irradiation: heterotopical ovarian autotransplantation. Cancer 1987; 60: 2201-4.
(9) Yin H, Wang X, Kim SS, Chen H, Tan SL, Gosden RG. Transplantation of intact rat gonads using vascular anastomosis: effects of cryopreservation, ischaemia and genotype. Hum Reprod 2003; 18:1165-72.
(10) Wang X, Chen H, Yin H, Kim SS, Lin Tan S, Gosden RG. Fertility after intact ovary transplantation. Nature 2002; 415: 385.
(11) Jeremias E, Bedaiwy MA, Gurunluoglu R, Biscotti CV, Siemionow M, Falcone T. Novel surgical technique for ovarian transplantation. Fertil Steril 2001; 76 (Suppl 3): S43.
(12) Marconi G, Quintana R, Rueda-Leverone NG, Vighi, S. Accidental ovarian autograft after a laparoscopic surgery: case report. Fertil Steril 1997; 68: 364-6.
(13) Oktay K, Buyuk E, Rosenwaks Z, Rucinski J. A technique for transplantation of ovarian cortical strips to the forearm. Fertil Steril 2003; 80:193-8.
(14) Oktay K, Economos K, Kan M, Rucinski J, Veeck L, Rosenwaks Z. Endocrine function and oocyte retrieval after autologous transplantation of ovarian cortical stips to the forearm. JAMA 2001; 286:1490-3.
(15) Callejo J, Salvador C, Miralles A, Vilaseca S, Lailla JM, Balasch J. Long-term ovarian function evaluation after autografting by implantation with fresh and frozen-thawed human ovarian tissue. J Clin Endocrinol Metab 2001; 86(9): 4489-94.
(16) Cóppola F, Martínez J, Domínguez A, Pérez Campos H, Regules E, Nozar F, et al. Trasplante heterotópico de corteza ovárica en paciente joven con cáncer de cuello uterino. Rev Med Urug 2005; 21: 327-32.
(17) Robert Kuo-Kuang Lee. Blastocyst Development alter Cryopreservation and SubcutaneousTransplantation of Mouse Ovarian Tissue. Journal of Assisted Reproduction and Genetics 2005; 22(2): 95-101.
(18) Kim SS, Yang HW, Kang HG, Lee HH, Lee HC, Ko DS, et al. Quantitative assessment of ischemic tissue damage in ovarian cortical tissue with or without antioxidant (ascorbic acid) treatment. Fertil Stertil 2004; 82: 679-85.
(19) Cóppola F, Domínguez A, Martínez Torena J. La neoangiogénesis de los implantes ováricos. In: Actualidad y controversias en ginecología. Barcelona: Glosa, 2005: 11-4. v.5
(20) Dissen GA, Lara HE, Fahrenbach WH, Costa ME, Ojeda SR. Immature rat ovaries become revascularized rapidly after autotransplantation and show a gonadotropin-dependent increase in angiogenic factor gene expression. Endocrinology 1994; 134: 1146-54.
(21) Donnez J, Dolmans MM, Demylle D, Jadoul P, Pirard C, Squifflet J, et al. Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 2004; 364(9443): 1405-10.
(22) Meirow D, Levron J, Eldar-Geva T, Hardan I, Fridman E, Zalel Y, et al. Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med 2005; 353(3): 318-21.
(23) Lee DM, Yeoman RR, Battaglia DE, Stouffer RL, Zelinski-Wooten MB, Fanton JW, et al. Live birth after ovarian tissue transplant. Nature 2004; 428: 137-8.
(24) Oktay K, Buyuk E, Veeck L, Zaninovic N, Xu K, Takeuchi T, et al. Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet 2004; 363: 837-40.
(25) Oktay K, Karlikaya G. Ovarian function after transplantation of frozen, banked autologous ovarian tissue. N Engl J Med 2000; 342: 1919.
(26) Baird D, Webb R, Campbell B, Harkness L, Gosden R. Long-term ovarian function in sheep after ovariectomy and transplantation of autografts stored at-196 C. Endocrinology 1999; 140(1): 462-71.
(27) Oktay K, Aydin BA, Economos K, Rucinski J, Kan MT, Veeck L, et al. Restoration of ovarian function after autologous transplantation of ovarian tissue in the forearm. Fertil Steril 2000; 74 (Suppl 3): S79.
(28) Kim SS, Hwang IT, Lee HC. Heterotopic autotransplantation of cryobanked human ovarian tissue as a strategy to restore ovarian function. Fertil Steril 2004; 82(4): 930-2.