Autotransplantation of fragmented ovarian cortical tissue: a laparoscopic demonstration

Stine Aagaard Lunding; Susanne Elisabeth Pors; Stine Gry Kristensen; Claus Yding Andersen; Janni Vikkelsø Jeppesen; Kirsten Tryde Macklon; Anders Nyboe Andersen; Anette Tønnes Pedersen

doi:10.1016/j.fertnstert.2018.08.024

Autotransplantation of fragmented ovarian cortical tissue: a laparoscopic demonstration

Stine Aagaard Lunding, Susanne Elisabeth Pors^*, Stine Gry Kristensen, Claus Yding Andersen, Janni Vikkelsø Jeppesen, Kirsten Tryde Macklon, Anders Nyboe Andersen, Anette Tønnes Pedersen

^*Corresponding author for this work

7 Citations (Scopus)

Abstract

Objective: To describe and demonstrate a simple and secure procedure for laparoscopic autotransplantation of fragmented ovarian cortical tissue in women with diminished ovarian reserve as part of in vitro activation (IVA) of ovarian follicles. Design: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique. Setting: Fertility clinic and obstetrics and gynecology department at a university hospital. Patient(s): Women with idiopathic diminished ovarian reserve and indication for in vitro fertilization (IVF), aged 25 to 39 years with an antral follicle count bilaterally of ≤5, antimüllerian hormone level of ≤5 pmol/L, and two ovaries. Intervention(s): The laparoscopic autotransplantation consists of six steps: [1] obtaining ovarian cortical biopsy samples, [2] preparing the peritoneal pocket, [3] fragmenting the ovarian cortical tissue into pieces of approximately 1 mm ³ , [4] installing the tissue fragments into a catheter, [5] transplanting the tissue fragments into the peritoneal pocket, and [6] closing the peritoneal pocket with a surgical clip. After the procedure, the patients are evaluated with blood samples and ultrasound scans followed by controlled ovarian stimulation. Ethics committee approval was obtained. Main Outcome Measure(s): Feasibility of a six-step laparoscopic autotransplantation procedure using fragmented ovarian cortical tissue. Result(s): A simple, fast laparoscopic procedure for taking biopsy samples and autotransplanting cortical tissue fragments in an all-in-one procedure ensures the rapid handling and correct placement of the small tissue fragments. The procedure is performed in an outpatient setting with an operation time of 1 hour. We have performed this procedure on 20 patients with no complications. Conclusion(s): In vitro activation is a new, developing option for women in fertility treatment who have diminished ovarian reserve. Fragmentation of murine ovarian tissue has shown to suppress the Hippo pathway, thereby initiating proliferation and growth. This surgical procedure resembles that used when transplanting pieces of frozen-thawed ovarian tissue for fertility restoration, but the fragmented ovarian tissue is only 1 mm ³ , which makes it difficult to transplant. Until now no surgical procedures for transplanting small IVA fragments of cortical tissue has been published. With this video we report in detail a simple way of autotransplanting small fragments of IVA cortical tissue using what is already accessible in the operating theater. Among the many advantages of this procedure are its short duration (1 hour) and outpatient setting, which enable fast recovery and minimal postoperative pain. The procedure also allows fast handling and minimal manipulation of the tissue (limited to the fragmentation). The effect of autotransplantation of fragmented tissue in women with diminished ovarian reserve is currently being studied in ongoing trials. If the technique is combined with chemical IVA, a better outcome may be seen.

Original language	English
Journal	Fertility and Sterility
Volume	110
Issue number	6
Pages (from-to)	1181-1183
Number of pages	3
ISSN	0015-0282
DOIs	https://doi.org/10.1016/j.fertnstert.2018.08.024
Publication status	Published - 2018

Keywords

Autotransplantation
diminished ovarian reserve
in vitro activation
laparoscopy
premature ovarian failure

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10.1016/j.fertnstert.2018.08.024

http://www.fertstert.org/article/S0015028218318338/pdf

Cite this

@article{65a499b380cd4e68a4419dd8b7f40b3b,

title = "Autotransplantation of fragmented ovarian cortical tissue: a laparoscopic demonstration",

abstract = " Objective: To describe and demonstrate a simple and secure procedure for laparoscopic autotransplantation of fragmented ovarian cortical tissue in women with diminished ovarian reserve as part of in vitro activation (IVA) of ovarian follicles. Design: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique. Setting: Fertility clinic and obstetrics and gynecology department at a university hospital. Patient(s): Women with idiopathic diminished ovarian reserve and indication for in vitro fertilization (IVF), aged 25 to 39 years with an antral follicle count bilaterally of ≤5, antim{\"u}llerian hormone level of ≤5 pmol/L, and two ovaries. Intervention(s): The laparoscopic autotransplantation consists of six steps: [1] obtaining ovarian cortical biopsy samples, [2] preparing the peritoneal pocket, [3] fragmenting the ovarian cortical tissue into pieces of approximately 1 mm 3 , [4] installing the tissue fragments into a catheter, [5] transplanting the tissue fragments into the peritoneal pocket, and [6] closing the peritoneal pocket with a surgical clip. After the procedure, the patients are evaluated with blood samples and ultrasound scans followed by controlled ovarian stimulation. Ethics committee approval was obtained. Main Outcome Measure(s): Feasibility of a six-step laparoscopic autotransplantation procedure using fragmented ovarian cortical tissue. Result(s): A simple, fast laparoscopic procedure for taking biopsy samples and autotransplanting cortical tissue fragments in an all-in-one procedure ensures the rapid handling and correct placement of the small tissue fragments. The procedure is performed in an outpatient setting with an operation time of 1 hour. We have performed this procedure on 20 patients with no complications. Conclusion(s): In vitro activation is a new, developing option for women in fertility treatment who have diminished ovarian reserve. Fragmentation of murine ovarian tissue has shown to suppress the Hippo pathway, thereby initiating proliferation and growth. This surgical procedure resembles that used when transplanting pieces of frozen-thawed ovarian tissue for fertility restoration, but the fragmented ovarian tissue is only 1 mm 3 , which makes it difficult to transplant. Until now no surgical procedures for transplanting small IVA fragments of cortical tissue has been published. With this video we report in detail a simple way of autotransplanting small fragments of IVA cortical tissue using what is already accessible in the operating theater. Among the many advantages of this procedure are its short duration (1 hour) and outpatient setting, which enable fast recovery and minimal postoperative pain. The procedure also allows fast handling and minimal manipulation of the tissue (limited to the fragmentation). The effect of autotransplantation of fragmented tissue in women with diminished ovarian reserve is currently being studied in ongoing trials. If the technique is combined with chemical IVA, a better outcome may be seen. ",

keywords = "Autotransplantation, diminished ovarian reserve, in vitro activation, laparoscopy, premature ovarian failure",

author = "Lunding, {Stine Aagaard} and Pors, {Susanne Elisabeth} and Kristensen, {Stine Gry} and Andersen, {Claus Yding} and Jeppesen, {Janni Vikkels{\o}} and Macklon, {Kirsten Tryde} and Andersen, {Anders Nyboe} and Pedersen, {Anette T{\o}nnes}",

year = "2018",

doi = "10.1016/j.fertnstert.2018.08.024",

language = "English",

volume = "110",

pages = "1181--1183",

journal = "Fertility and Sterility",

issn = "0015-0282",

publisher = "Elsevier",

number = "6",

}

TY - JOUR

T1 - Autotransplantation of fragmented ovarian cortical tissue

T2 - a laparoscopic demonstration

AU - Lunding, Stine Aagaard

AU - Pors, Susanne Elisabeth

AU - Kristensen, Stine Gry

AU - Andersen, Claus Yding

AU - Jeppesen, Janni Vikkelsø

AU - Macklon, Kirsten Tryde

AU - Andersen, Anders Nyboe

AU - Pedersen, Anette Tønnes

PY - 2018

Y1 - 2018

N2 - Objective: To describe and demonstrate a simple and secure procedure for laparoscopic autotransplantation of fragmented ovarian cortical tissue in women with diminished ovarian reserve as part of in vitro activation (IVA) of ovarian follicles. Design: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique. Setting: Fertility clinic and obstetrics and gynecology department at a university hospital. Patient(s): Women with idiopathic diminished ovarian reserve and indication for in vitro fertilization (IVF), aged 25 to 39 years with an antral follicle count bilaterally of ≤5, antimüllerian hormone level of ≤5 pmol/L, and two ovaries. Intervention(s): The laparoscopic autotransplantation consists of six steps: [1] obtaining ovarian cortical biopsy samples, [2] preparing the peritoneal pocket, [3] fragmenting the ovarian cortical tissue into pieces of approximately 1 mm 3 , [4] installing the tissue fragments into a catheter, [5] transplanting the tissue fragments into the peritoneal pocket, and [6] closing the peritoneal pocket with a surgical clip. After the procedure, the patients are evaluated with blood samples and ultrasound scans followed by controlled ovarian stimulation. Ethics committee approval was obtained. Main Outcome Measure(s): Feasibility of a six-step laparoscopic autotransplantation procedure using fragmented ovarian cortical tissue. Result(s): A simple, fast laparoscopic procedure for taking biopsy samples and autotransplanting cortical tissue fragments in an all-in-one procedure ensures the rapid handling and correct placement of the small tissue fragments. The procedure is performed in an outpatient setting with an operation time of 1 hour. We have performed this procedure on 20 patients with no complications. Conclusion(s): In vitro activation is a new, developing option for women in fertility treatment who have diminished ovarian reserve. Fragmentation of murine ovarian tissue has shown to suppress the Hippo pathway, thereby initiating proliferation and growth. This surgical procedure resembles that used when transplanting pieces of frozen-thawed ovarian tissue for fertility restoration, but the fragmented ovarian tissue is only 1 mm 3 , which makes it difficult to transplant. Until now no surgical procedures for transplanting small IVA fragments of cortical tissue has been published. With this video we report in detail a simple way of autotransplanting small fragments of IVA cortical tissue using what is already accessible in the operating theater. Among the many advantages of this procedure are its short duration (1 hour) and outpatient setting, which enable fast recovery and minimal postoperative pain. The procedure also allows fast handling and minimal manipulation of the tissue (limited to the fragmentation). The effect of autotransplantation of fragmented tissue in women with diminished ovarian reserve is currently being studied in ongoing trials. If the technique is combined with chemical IVA, a better outcome may be seen.

AB - Objective: To describe and demonstrate a simple and secure procedure for laparoscopic autotransplantation of fragmented ovarian cortical tissue in women with diminished ovarian reserve as part of in vitro activation (IVA) of ovarian follicles. Design: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique. Setting: Fertility clinic and obstetrics and gynecology department at a university hospital. Patient(s): Women with idiopathic diminished ovarian reserve and indication for in vitro fertilization (IVF), aged 25 to 39 years with an antral follicle count bilaterally of ≤5, antimüllerian hormone level of ≤5 pmol/L, and two ovaries. Intervention(s): The laparoscopic autotransplantation consists of six steps: [1] obtaining ovarian cortical biopsy samples, [2] preparing the peritoneal pocket, [3] fragmenting the ovarian cortical tissue into pieces of approximately 1 mm 3 , [4] installing the tissue fragments into a catheter, [5] transplanting the tissue fragments into the peritoneal pocket, and [6] closing the peritoneal pocket with a surgical clip. After the procedure, the patients are evaluated with blood samples and ultrasound scans followed by controlled ovarian stimulation. Ethics committee approval was obtained. Main Outcome Measure(s): Feasibility of a six-step laparoscopic autotransplantation procedure using fragmented ovarian cortical tissue. Result(s): A simple, fast laparoscopic procedure for taking biopsy samples and autotransplanting cortical tissue fragments in an all-in-one procedure ensures the rapid handling and correct placement of the small tissue fragments. The procedure is performed in an outpatient setting with an operation time of 1 hour. We have performed this procedure on 20 patients with no complications. Conclusion(s): In vitro activation is a new, developing option for women in fertility treatment who have diminished ovarian reserve. Fragmentation of murine ovarian tissue has shown to suppress the Hippo pathway, thereby initiating proliferation and growth. This surgical procedure resembles that used when transplanting pieces of frozen-thawed ovarian tissue for fertility restoration, but the fragmented ovarian tissue is only 1 mm 3 , which makes it difficult to transplant. Until now no surgical procedures for transplanting small IVA fragments of cortical tissue has been published. With this video we report in detail a simple way of autotransplanting small fragments of IVA cortical tissue using what is already accessible in the operating theater. Among the many advantages of this procedure are its short duration (1 hour) and outpatient setting, which enable fast recovery and minimal postoperative pain. The procedure also allows fast handling and minimal manipulation of the tissue (limited to the fragmentation). The effect of autotransplantation of fragmented tissue in women with diminished ovarian reserve is currently being studied in ongoing trials. If the technique is combined with chemical IVA, a better outcome may be seen.

KW - Autotransplantation

KW - diminished ovarian reserve

KW - in vitro activation

KW - laparoscopy

KW - premature ovarian failure

U2 - 10.1016/j.fertnstert.2018.08.024

DO - 10.1016/j.fertnstert.2018.08.024

M3 - Journal article

C2 - 30396563

AN - SCOPUS:85055900319

SN - 0015-0282

VL - 110

SP - 1181

EP - 1183

JO - Fertility and Sterility

JF - Fertility and Sterility

IS - 6

ER -

Autotransplantation of fragmented ovarian cortical tissue: a laparoscopic demonstration

Abstract

Keywords

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