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Hum. Reprod. Advance Access published online on November 16, 2006
Human Reproduction, doi:10.1093/humrep/del440
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received April 28, 2006
Revised July 18, 2006
Accepted September 18, 2006

Article

Fresh human orthotopic ovarian cortex transplantation: long-term results

M. Sánchez 1, P. Alamá 2, B. Gadea 3, S.R. Soares 3, C. Simón 3, and A. Pellicer 1 *

1 Department of Obstetrics and Gynaecology, Hospital Universitario Dr Peset, Valencia, Spain; Instituto Universitario Valenciano de Infertilidad (IVI), University of Valencia, Valencia, Spain
2 Department of Obstetrics and Gynaecology, Hospital Universitario Dr Peset, Valencia, Spain
3 Instituto Universitario Valenciano de Infertilidad (IVI), University of Valencia, Valencia, Spain

* To whom correspondence should be addressed.
A. Pellicer, E-mail: pellicer_ant{at}gva.es


  Abstract

BACKGROUND: Ovarian orthotopic transplantation in patients with premature ovarian failure is reported to result in full-term pregnancies. Ischaemia and freezing/thawing are potentially injurious for tissues. This study was designed to analyse the effect of ischaemia on long-term ovarian function in humans. METHODS: Prospective case-control study. Subjects were 12 premenopausal women undergoing hysterectomy and fresh orthotopic transplantation of the entire ovarian cortex plus a control group of five patients undergoing hysterectomy only. Follow-up lasted 2 years. Serum FSH and anti-Müllerian hormone (AMH) were recorded, and ovulatory cycles were determined by vaginal ultrasound and serum progesterone levels. RESULTS: Follow-up showed that ovulation was restored in 11 of the 12 patients who received grafts over the duration of the study (9.3 ± 1.73 ovulations versus 12.0 ± 0.86 in controls, NS), and 9 of 12 patients remained ovulatory after 2 years. We identified four patterns of FSH secretion during the study, 5 of 12 (41.7%) women having the same pattern as controls. There was a trend for serum AMH levels 7 days after surgery (0.16 ± 0.02 mg/l) to be lower than pre-surgery levels (0.38 ± 0.09 mg/l, P = 0.07) and higher in women whose FSH patterns suggested normal ovarian function, but the results did not reach significance. After transplantation, FSH correlated more closely (r = -0.639, P = 0.02) with normal ovarian function than AMH (r = 0.465, P = 0.12). CONCLUSIONS: Fresh orthotopic ovarian cortex transplantation is a viable procedure. It maintains normal ovarian function after 2 years in 75% of cases and preserves ovarian function against ischaemia in 41.7% of patients.

Keywords: anti-Müllerian hormone/FSH/ischaemia/ovarian orthotopic transplantation.
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