Young girls who are about to undergo treatment for cancer or other therapies that pose high risk of infertility can opt to have an ovary removed and preserved for future transplantation when they are ready to pursue pregnancy. However, the tiny ovary can be easily damaged during surgery and the quality of ovarian tissue for fertility preservation is affected by the surgical removal technique, according to a study from Ann & Robert H. Lurie Children's Hospital of Chicago published in the Journal of Pediatric Surgery . Using an experimental piglet model, researchers defined the safest laparoscopic technique for removing the ovary that also results in the best quality ovarian tissue for later use.
We are already applying our findings for all ovary removals for fertility preservation. The evidence from our study is the first step to defining standard of care surgical technique in prepubertal girls that will allow us to maximize ovarian tissue health and hopefully increase pregnancy rates after the tissue is transplanted back." Erin Rowell, MD, lead author, Director of the Fertility & Hormone Preservation & Restoration Program at Lurie Children's and Associate Professor of Surgery at Northwestern University Feinberg School of Medicine
To preserve future fertility, the removed ovarian tissue is frozen - a process called cryopreservation. When a woman is ready to have a child, one of the current options is to transplant the preserved tissue onto the remaining ovary, where it starts to function normally and enables natural pregnancy. This technique is still considered experimental.
To date, two live births have been documented in women who had ovarian tissue cryopreservation as prepubertal girls, while over 130 live births occurred in women whose ovarian tissue was removed and cryopreserved after they reached puberty. Currently, less than a third of women who had their ovarian tissue transplanted back experienced a successful pregnancy.
To evaluate the quality of ovarian tissue after different surgical removal techniques, Dr. Rowell performed laparoscopic ovary removal in piglets. The goal was to simulate this surgery as precisely as possible, using the same type of instruments that are used in young girls, including an ultrasonic advanced energy device that provides heat to cut and cauterize tissue around the ovary. The piglet's ovarian tissue was then processed exactly the same way as human tissue would be handled for fertility preservation. Related Stories
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