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

Authors:

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.

Abstract:

Objective

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


Design

Case series with meta-analytic update.


Setting

Academic.


Patient(s)

Seven recipients of RA-ACOTT.


Intervention(s)

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.


Result(s)

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.


Conclusion(s)

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.