SpringerLink
Log in

Heterotopic ovarian transplantation instead hormonal replacement therapy after radical hysterectomy for cervical cancer: case report and review of literature

  • Fertility Preservation
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

Only a few case reports have described heterotopic ovarian tissue transplantation (OTT) with the only objective of restoring ovarian function.

Methods

Case report and review of the literature for reporting cases of heterotopic OTT with the only aim of restoring ovarian endocrine function. In a cancer survivor woman with a history of hysterectomy and bilateral oophorectomy for cervical cancer and because she poorly tolerated hormone replacement therapy (HRT), we performed a heterotopic OTT in a pelvic subcutaneous “pocket” after an OT cryostorage of 17 years.

Results

A cyclic ovarian endocrine function started 3 months after OTT with an immediate patient self-described improvement of her quality of life. A second OTT was performed 19 months after, due to hot flushes recurrence and FSH increase. Despite a cyclic endocrine function, progesterone levels have always been low, resulting in a relative hyperoestrogenism state.

Conclusion

In the future, the indications of heterotopic OTT could be spread in alternative to HRT. However, our data suggest that the heterotopic graft environment is less favorable to corpus luteum development, and further studies are needed to assay the best site of heterotopic graft, the optimal number of ovarian cortex fragments to graft, and the potential risk of relapse in case of malignant residual disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Data availability

Data will be made available to the editors of the journal for review or query upon request.

References

  1. ESHRE Guideline Group on Female Fertility Preservation, Anderson RA, Amant F, Braat D, D’Angelo A, Chuva de Sousa Lopes SM, et al. ESHRE guideline: female fertility preservation. Hum Reprod Open. 2020;2020:hoaa052. https://doi.org/10.1093/hropen/hoaa052.

  2. Donnez J, Dolmans MM, Demylle D, Jadoul P, Pirard C, Squifflet J, et al. Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet. 2004;364:1405–10. https://doi.org/10.1016/S0140-6736(04)17222-X.

    Article  CAS  PubMed  Google Scholar 

  3. Dolmans M-M, von Wolff M, Poirot C, Diaz-Garcia C, Cacciottola L, Boissel N, et al. Transplantation of cryopreserved ovarian tissue in a series of 285 women: a review of five leading European centers. Fertil Steril. 2021;115:1102–15. https://doi.org/10.1016/j.fertnstert.2021.03.008.

    Article  CAS  PubMed  Google Scholar 

  4. Callejo J, Salvador C, Miralles A, Vilaseca S, Lailla JM, Balasch J. Long-term ovarian function evaluation after autografting by implantation with fresh and frozen-thawed human ovarian tissue. J Clin Endocrinol Metab. 2001;86:4489–94. https://doi.org/10.1210/jcem.86.9.7871.

    Article  CAS  PubMed  Google Scholar 

  5. Kim SS, Hwang I-T, Lee H-C. Heterotopic autotransplantation of cryobanked human ovarian tissue as a strategy to restore ovarian function. Fertil Steril. 2004;82:930–2. https://doi.org/10.1016/j.fertnstert.2004.02.137.

    Article  PubMed  Google Scholar 

  6. Poirot C, Abirached F, Prades M, Coussieu C, Bernaudin F, Piver P. Induction of puberty by autograft of cryopreserved ovarian tissue. Lancet. 2012;379:588. https://doi.org/10.1016/S0140-6736(11)61781-9.

    Article  PubMed  Google Scholar 

  7. Oktay KH, Marin L. Comparison of orthotopic and heterotopic autologous ovarian tissue transplantation outcomes. Fertil Steril 2023:S0015-0282(23)01933-7. https://doi.org/10.1016/j.fertnstert.2023.10.015.

  8. Khattak H, Malhas R, Craciunas L, Afifi Y, Amorim CA, Fishel S, et al. Fresh and cryopreserved ovarian tissue transplantation for preserving reproductive and endocrine function: a systematic review and individual patient data meta-analysis. Hum Reprod Update. 2022;28:400–16. https://doi.org/10.1093/humupd/dmac003.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim SS, Lee WS, Chung MK, Lee HC, Lee HH, Hill D. Long-term ovarian function and fertility after heterotopic autotransplantation of cryobanked human ovarian tissue: 8-year experience in cancer patients. Fertil Steril. 2009;91:2349–54. https://doi.org/10.1016/j.fertnstert.2008.04.019.

    Article  PubMed  Google Scholar 

  10. Kim SS. Assessment of long term endocrine function after transplantation of frozen-thawed human ovarian tissue to the heterotopic site: 10 year longitudinal follow-up study. J Assist Reprod Genet. 2012;29:489–93. https://doi.org/10.1007/s10815-012-9757-3.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Baird DT, Campbell B, de Souza C, Telfer E. Long-term ovarian function in sheep after ovariectomy and autotransplantation of cryopreserved cortical strips. Eur J Obstet Gynecol Reprod Biol. 2004;113(Suppl 1):S55-59. https://doi.org/10.1016/j.ejogrb.2003.11.023.

    Article  PubMed  Google Scholar 

  12. Ablove TS, Austin JL, Phernetton TM, Magness RR. Effects of endogenous ovarian estrogen versus exogenous estrogen replacement on blood flow and ERβα and ERβ levels in the bladder. Reprod Sci. 2009;16:657–64. https://doi.org/10.1177/1933719109334255.

    Article  CAS  PubMed  Google Scholar 

  13. Grubliauskaite M, van der Perk MEM, Bos AME, Meijer AJM, Gudleviciene Z, van den Heuvel-Eibrink MM, et al. Minimal infiltrative disease identification in cryopreserved ovarian tissue of girls with cancer for future use: a systematic review. Cancers (Basel). 2023;15: 4199. https://doi.org/10.3390/cancers15174199.

    Article  CAS  PubMed  Google Scholar 

  14. Chen J, Wang R, Zhang B, Lin X, Wei J, Jia Y, et al. Safety of ovarian preservation in women with stage I and II cervical adenocarcinoma: a retrospective study and meta-analysis. Am J Obstet Gynecol. 2016;215:460.e1-460.e13. https://doi.org/10.1016/j.ajog.2016.04.023.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecology-Obstetric and Reproductive Medicine - CECOS, AP-HM, Hôpital La Conception, Marseille, France

    Blandine Courbiere, Laura Miquel, Pauline Bottin, Jacqueline Saias-Magnan & Catherine Metzler-Guillemain

  2. IMBE, Aix-Marseille Univ, CNRS, IRD, Avignon Univ, Marseille, France

    Blandine Courbiere

  3. Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France

    Magali Provansal

  4. INSERM, MMG, Aix Marseille Univ, Marseille, France

    Catherine Metzler-Guillemain

  5. Department of Gynecology - Obstetric and Reproductive Medicine , 147 bd Baille, Marseille, 13005, France

    Blandine Courbiere

Authors
  1. Blandine Courbiere
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Miquel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pauline Bottin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Magali Provansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacqueline Saias-Magnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Catherine Metzler-Guillemain
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BC and CMG accompanied the patient throughout her entire medical journey, coordinating with heterotopic OTT. MP played a pivotal role as the oncology reference. BC, PB, and LM conducted experiments, and BC authored the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Blandine Courbiere.

Ethics declarations

Ethical approval

No ethical approval needed, because in our country, the law authorizes ovarian autograft to restore endocrine function up to the age of 50.

Consent for publication

The patient gave a written consent for publication and for the retrospective analyses of their medical data.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Courbiere, B., Miquel, L., Bottin, P. et al. Heterotopic ovarian transplantation instead hormonal replacement therapy after radical hysterectomy for cervical cancer: case report and review of literature. J Assist Reprod Genet (2024). https://doi.org/10.1007/s10815-024-03196-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10815-024-03196-5

Keywords

Search

Navigation