Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; Innovation Fertility Preservation and IVF, New York, New York.
Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; Department of Women's and Children's Health, University of Padua, Padua, Province of Padua, Italy.
Fertil Steril. 2024 Jan;121(1):72-79. doi: 10.1016/j.fertnstert.2023.10.015. Epub 2023 Oct 14.
To compare the outcomes of orthotopic and heterotopic ovarian tissue transplantation (OTT) techniques.
Mixed prospective-retrospective cohort study.
Academic hospital.
A total of 14 recipients of autologous OTT.
Of the 14 women, 12 who received orthotopic (n = 6) or heterotopic (n = 6) transplants met the inclusion criteria. All orthotopic transplants and one heterotopic ovarian tissue transplant were performed laparoscopically. Although 5 of the 6 remaining heterotopic transplants were performed subcutaneously under local anesthesia or intravenous sedation, one was performed with robotic assistance. With the exception of one recipient who solely desired restoration of endocrine function, all underwent oocyte retrieval either to cryopreserve oocytes and embryos before the graft function ceased or because they could not otherwise conceive (hysterectomy, radiation damage, and heterotopic transplant).
Primary outcome measures were graft function and longevity, and the number of embryos generated per retrieval.
The mean age at ovarian tissue harvesting and transplantation was lower in patients with orthotopic vs. heterotopic transplants, although the proportion of transplanted ovarian cortex was lower in heterotopic transplant cases. All grafts restored ovarian endocrine function. Fertilization rates, the number of embryos generated per retrieval, and the mean number of nonarrested embryos were significantly lower in heterotopic OTT. However, time to function and graft longevity were similar between the groups. Although 4 of the 6 women conceived and delivered 7 children among orthotopic ovarian tissue recipients, one recipient had 3 spontaneous live births after heterotopic OTT, presumably because of the induction of function in the remaining menopausal ovary.
It appears that orthotopic OTT results in higher gamete and embryo quality. However, the endocrine function restoration rate and longevity are similar between the 2 approaches. When feasible, orthotopic OTT should be preferred for those who intend to conceive, although a less invasive heterotopic OTT can be performed for those who primarily desire ovarian endocrine function.
比较原位和异位卵巢组织移植（OTT）技术的结果。
混合前瞻性回顾性队列研究。
学术医院。
共 14 名接受自体 OTT 的患者。
在 14 名女性中，有 12 名接受了原位（n=6）或异位（n=6）移植，符合纳入标准。所有原位移植和 1 例异位卵巢组织移植均经腹腔镜完成。尽管 6 例异位移植中有 5 例在局部麻醉或静脉镇静下经皮下进行，但有 1 例采用机器人辅助。除 1 名仅希望恢复内分泌功能的患者外，所有患者均进行了卵母细胞采集，要么是在移植物功能丧失之前冷冻保存卵母细胞和胚胎，要么是因为无法受孕（子宫切除术、放射损伤和异位移植）。
主要观察指标为移植物功能和存活时间，以及每次采集的胚胎数量。
虽然原位移植患者的卵巢组织采集和移植年龄较低，但异位移植患者的移植卵巢皮质比例较低。所有移植物均恢复了卵巢内分泌功能。异位 OTT 的受精率、每次采集的胚胎数量和非阻滞胚胎的平均数量明显较低。然而，两组之间的功能启动时间和移植物存活时间相似。尽管 6 名接受原位卵巢组织移植的患者中有 4 名受孕并分娩了 7 名儿童，但 1 名患者在接受异位 OTT 后自然分娩了 3 名活产婴儿，这可能是由于剩余绝经卵巢的功能诱导。
似乎原位 OTT 可获得更高质量的配子和胚胎。然而，两种方法的内分泌功能恢复率和存活时间相似。如果可行，对于那些打算受孕的患者，应首选原位 OTT，而对于那些主要希望恢复卵巢内分泌功能的患者，可以进行侵袭性较小的异位 OTT。
