Preliminary experience with orthotopic and heterotopic transplantation of ovarian cortical strips.

The idea of fresh orthotopic autologous ovarian transplantation in humans is neither novel nor sophisticated; a New York surgeon reported on this technique as early as in 1906. It is the recent possibility of cryostorage of ovarian tissue and the development of new orthotopic and heterotopic techniques to autotransplant frozen-thawed ovarian cortical strips that brought a new dimension to the field. With the availability of more effective cryoprotectants, researchers were able to demonstrate that ovarian function and fertility could be restored after transplantation of cryopreserved ovarian tissue in large mammals. Experimental models of ovarian transplantation are discussed in the article by Shaw and Trounson; our focus will be on the clinical applications of ovarian transplantation and new developments in heterotopic transplantation. Patient selection and screening, details of the surgical techniques, and safety measures to avoid reseeding cancer cells via transplanted tissue will be discussed. Synchronization between the laboratory and the operating room will be detailed to provide guidance for clinicians who are contemplating ovarian transplantation with previously frozen ovarian tissue.