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. 2024 Jan;121(1):72-79.
doi: 10.1016/j.fertnstert.2023.10.015. Epub 2023 Oct 14.

Comparison of orthotopic and heterotopic autologous ovarian tissue transplantation outcomes

Kutluk H Oktay  1 , Loris Marin  2
Affiliations

Comparison of orthotopic and heterotopic autologous ovarian tissue transplantation outcomes

Kutluk H Oktay et al. Fertil Steril. 2024 Jan.

Abstract
in English, Spanish

Objective: To compare the outcomes of orthotopic and heterotopic ovarian tissue transplantation (OTT) techniques.

Design: Mixed prospective-retrospective cohort study.

Setting: Academic hospital.

Patients: A total of 14 recipients of autologous OTT.

Interventions: 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).

Main outcome measures: Primary outcome measures were graft function and longevity, and the number of embryos generated per retrieval.

Results: 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.

Conclusions: 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.

Objetivo:: Comparar los resultados de las técnicas de trasplante de tejido ovárico (OTT) ortotόpico y heterotόopico.

Diseño:: Estudio mixto de cohorte prospectivo-retrospectivo.

Lugar:: Hospital Académico.

Pacientes:: Un total de 14 receptores de OTT autolόgos.

Intervenciones:: De las 14 mujeres, 12 que recibieron trasplantes ortotόpicos (n 1⁄4 6) o heterotόpicos (n 1⁄4 6) cumplieron los criterios de inclusiόn. Todos los trasplantes ortotόpicos y un trasplante heterotόpico de tejido ovárico se realizaron por vía laparoscόpica. Aunque 5 de los 6 restantes trasplantes heterotόopicos se realizaron por vía subcutáanea bajo anestesia local o sedaciόon intravenosa, uno serealizόo con asistencia robόotica. Con la excepciόon de una receptora que solo deseaba la restauraciόon de la funciόon endocrina, todas sesometieron a la extracciόon de ovocitos ya sea para criopreservar ovocitos y embriones antes de que cesara la funciόon del injerto o porque no podían concebir de otra manera (histerectomía, dañno por radiaciόon y trasplante heterotόopico).

Principales medidas de resultado:: Las medidas de resultado primarias fueron la funciόon y la longevidad del injerto, y el núumero de embriones generados por extracciόon.

Resultados:: La edad media de extracciόon y trasplante de tejido ováarico fue menor en las pacientes con trasplantes ortotόopicos frente a los heterotόopicos, aunque la proporciόon de corteza ováarica trasplantada fue menor en los casos de trasplante heterotόopico. Todos los injertos restauraron la funciόon endocrina ováarica. Las tasas de fecundaci_on, el nόumero de embriones generados por recuperaciόon y el núumero medio de embriones no detenidos fueron significativamente menores en la OTT heterotόopica. Sin embargo, el tiempo de funcionamiento y la longevidad del injerto fueron similares entre los grupos. Aunque 4 de las 6 mujeres concibieron y dieron a luz a 7 hijos entre las receptoras de tejido ováarico ortotόopico, una receptora tuvo 3 nacimientos vivos espontáaneos despuées de la OTT heterotόopica, presumiblemente debido a la inducciόon de la funciόon en el ovario menopáausico restante.

Conclusiones:: Parece que la OTT ortotόopica resulta en una mayor calidad de gametos y embriones. Sin embargo, la tasa de restauraciόon de la funciόon endocrina y la longevidad son similares entre los 2 enfoques. Cuando sea posible, se debe preferir la OTT ortotόopica paraaquellas que tienen la intenciόon de concebir, aunque se puede realizar una OTT heterotόopica menos invasiva para aquellas que desean principalmente la funciόon endocrina ováarica.

Keywords: Fertility preservation; heterotopic transplantation; orthotopic transplantation; ovarian tissue transplantation; reproductive Surgery.

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Conflict of interest statement

Declaration of interests K.H.O. has nothing to disclose. L.M. has nothing to disclose.

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