Laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation in children

Abstract

Background/purpose: Many survivors of childhood cancer will experience premature gonadal insufficiency or infertility as a consequence of their medical treatments. Ovarian tissue cryopreservation (OTC) remains an experimental means of fertility preservation with few reports focused on the surgical technique and postoperative outcomes for OTC in children.

Methods: This is a single institution, retrospective review of OTC cases from January 2011 to December 2017. Children were eligible for OTC if they had a greater than 80% risk of premature ovarian insufficiency or infertility owing to their anticipated gonadotoxic medical treatment.

Results: OTC was performed in 64 patients. Median age was 12 years old (range: 5 months-23 years). Nearly half (48%) of the patients were premenarchal. Laparoscopic unilateral oophorectomy was performed in 84% of patients. There were no surgical complications. In 76% of patients, OTC was performed in conjunction with an ancillary procedure. The majority (96%) of patients were discharged within 24 hours. Median time from operation to medical therapy was six days, with no unanticipated treatments delays attributable to OTC.

Conclusions: Laparoscopic unilateral oophorectomy for OTC can be performed safely, in combination with other ancillary procedures, as an outpatient procedure without delaying medical therapy for children facing a fertility-threatening diagnosis or treatment.

Level of evidence: IV.

Keywords: Children; Fertility preservation; Laparoscopy; Oophorectomy; Ovarian tissue cryopreservation.

Fig. 1

Suggested port placement for laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation by age category ^a Infant, ^b prepubertal, ^c/d adolescent/young adult.

Fig. 2

Intraoperative images during laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation ^a Display of a prepubertal ovary, ^b division of the mesovarium from medial to lateral in a post-pubertal patient, ^c division of the vascular pedicle in a prepubertal patient.

Fig. 3

Diagnosis, treatment, and pathology of 64 children who underwent ovarian tissue cryopreservation from 1/2011 to 12/2017 ^a Details can be found in the body of the text.