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Human Reproduction Update Advance Access published online on May 27, 2009
Human Reproduction Update, doi:10.1093/humupd/dmp021
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
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Orthotopic and heterotopic ovarian tissue transplantation

I. Demeestere1,2,3, P. Simon2, S. Emiliani2, A. Delbaere1,2 and Y. Englert1,2

1 Research Laboratory on Human Reproduction, Medicine Faculty, Université Libre de Bruxelles (ULB), Erasme Hospital, 808 Route de Lennik, 1070 Brussels, Belgium 2 Fertility Clinic, Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB), Erasme Hospital, 808 Route de Lennik, 1070 Brussels, Belgium

To whom correspondence should be addressed at: 3 Correspondence address. Tel: +32-2-5556358; Fax: +32-2-5556205; E-mail: idemeest{at}ulb.ac.be

BACKGROUND: Transplantation of ovarian tissue is, at present, the only clinical option available to restore fertility using cryopreserved ovarian tissue. More than 30 transplantations of cryopreserved tissue have been reported, and six babies have been born, worldwide, following this procedure. Despite these encouraging results, it is essential to optimize the procedure by improving the follicular survival, confirming safety and developing alternatives. Here, we review the different factors affecting follicular survival and growth after grafting.

METHODS: Relevant studies were identified by searching Pubmed up to January 2009 with English language limitation. The following key words were used: (ovarian tissue or whole ovary) AND (transplantation) AND (cryopreservation or pregnancy). Using the literature and personal experience, we examined relevant data on the different exogenous and clinical factors affecting follicular development after grafting.

RESULTS: Clinical factors such as the patient's age and the transplantation sites influenced the lifespan of the graft. A heterotopic transplantation site is not optimal but offers some advantages and it may also promote the hormonal environment after a combined heterotopic and orthotopic transplantation. Exogenous factors such as antioxidants, growth factors or hormones were tested to improve follicular survival; however, their efficiency regarding further follicular development and fertility potential remains to be established.

CONCLUSION: Additional evidence is required to define optimal conditions for ovarian tissue transplantation. Alternatives such as whole ovary or isolated follicles transplantations require further investigation but are likely to be successful in humans in the future.

Key words: ovarian tissue / transplantation / pregnancy / sites / vascularization

Received on January 15, 2009; revised April 20, 2009; accepted on April 24, 2009


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