Ovarian transplantation with robotic surgery and a neovascularizing human extracellular matrix scaffold: a case series in comparison to meta-analytic data

Orthotopic ovarian tissue transplantation with robotic surgery and a neovascularizing human extracellular matrix scaffold results in high success on the basis of longevity, endocrine function, follicle development, embryo development, and live births.

VOLUME 117, ISSUE 1, P181-192


Kutluk Oktay, M.D., Ph.D., Loris Marin, M.D., Giuliano Bedoschi, M.D., Fernanda Pacheco, M.D., Yodo Sugishita, M.D., Ph.D., Tai Kawahara, M.D., Enes Taylan, M.D., Carlo Acosta, B.S., Heejung Bang, Ph.D.



To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transplantation (ACOTT) with the use of a neovascularizing extracellular matrix scaffold.


Case series with meta-analytic update.




Seven recipients of RA-ACOTT.


Before or shortly after initiating chemotherapy, ovarian tissue was cryopreserved from 7 women, who then underwent RA-ACOTT 9.9 ± 1.8 years (range, 7–12 years) later. Perioperatively, they received transdermal estrogen and low-dose aspirin to enhance graft vascularization. Ovarian cortical pieces were thawed and sutured on an extracellular matrix scaffold, which was then robotically anastomosed to the bivalved remaining ovary in 6 cases and retroperitoneally (heterotopic) to the lower abdomen in 1 case.

Main Outcome Measure(s)

Ovarian function return, the number of oocytes/embryos, aneuploidy %, live births, and neonatal outcomes were recorded. Graft longevity was compared with the mean from the meta-analytic data.


Ovarian function returned 13.9 ± 2.7 weeks (11–16.2 weeks) after ACOTT, and oocytes were retrieved in all cases with 12.3 ± 6.9 embryos generated. In contrast to orthotopic, the heterotopic ACOTT demonstrated low embryo quality and an 80% aneuploidy rate. A recipient did not attempt to conceive and 2 needed a surrogate, whereas 4 of 4 delivered 6 healthy children, compared with 115 of 460 (25% pregnancy rate) from the meta-analytic data (n = 79). The mean graft longevity (43.2 ± 23.6/47.4 ± 22.8 months with/without sensitivity analysis) trended longer than the meta-analytic mean (29.4 ± 22.7), even after matching age at cryopreservation.


In this series, RA-ACOTT resulted in extended graft longevity, with ovarian functions restored in all cases, even when the tissues were cryopreserved after chemotherapy exposure.