Ovarian transposition
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memo https://doi.org/10.1007/s12254-020-00646-5
Ovarian transposition Elisabeth Reiser · Bettina Böttcher · Danijela Minasch · Julian Mangesius · Bettina Toth
Received: 31 May 2020 / Accepted: 18 August 2020 © The Author(s) 2020
Summary Cytotoxic chemotherapy regimens and radiotherapy can lead to acute ovarian failure, premature ovarian insufficiency and menopause. Fertility preservation options before radiotherapy include ovarian transposition, where one or both ovaries are placed outside the radiation field. However, the efficacy of ovarian transposition is questioned, as the conservation of ovarian function varies between 17 and 95% in the literature.
cancer need to be counseled on fertility preservation options as they wish to have children in the future [6]. Fertility preservation options before radiotherapy include ovarian transposition (OT), cryopreservation of ovarian tissue and/or ovarian stimulation with cryopreservation of (fertilized) oocytes. The different techniques can also be combined depending on patient age, planned radiotherapy and the necessity of chemotherapy.
Keywords Fertility preservation · Ovarian function · Radiotherapy · Gonadotoxic therapy · Surgery
Surgical procedure
Introduction Pelvic radiotherapy is a standardized treatment in gynecologic, anal or rectal cancer as well as Hodgkin lymphoma [1, 2]. It disturbs gonadal function and can cause primary ovarian insufficiency (POI) ending up in infertility [3]. The extent of damage to ovarian function depends on several factors: patient age, radiation dosage, radiation field and possible combination with chemotherapy. In the case of pregnancy after cancer treatment, the risks of miscarriage, stillbirth, preterm birth and abnormal placentation may be increased [4, 5]. As survival rates of cancer patients are constantly increasing, fertility sparing is of growing interest and importance. More than 75% of patients suffering from
E. Reiser () · B. Böttcher · B. Toth Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria [email protected] D. Minasch · J. Mangesius Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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Ovarian transposition was first established in 1952 by Batten to reduce the exposure of the female gonads to high radiation doses [7]. Mainly by laparoscopy, one or both ovaries are (temporarily) positioned at least 2 cm above the pelvic brim. After ligating the Fallopian tube and the ovarian ligament, the ovary is attached to the abdominal wall. Both ovaries are marked with titanium metallic clips to determine their exact position in future controls. The achieved distance to the radiation field is of great importance, as in a 10-cm distance there is still 10% of radiation dosage active [8]. In a multivariate analysis, the position of the fixed ovary was the greatest prognostic factor for preservation of ovarian function [9]. The risks of the procedure itself are described as l
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