Presented by:
Chris Vizena
Affiliations:
University of Toronto – Mount Sinai & THP
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What is Unilateral Oophorectomy for Ovarian Tissue Cryopreservation?
Unilateral oophorectomy for ovarian tissue cryopreservation is a fertility-preservation procedure in which one ovary is laparoscopically removed so that ovarian tissue can be processed and frozen for potential future use. It may be considered for patients at risk of losing ovarian function from treatments such as chemotherapy, radiation, or other gonadotoxic therapies, particularly when there is limited time or conventional egg or embryo freezing is not appropriate. Here’s what it involves:
- Patient Selection: Fertility goals, age, ovarian reserve, underlying diagnosis, planned treatment, and risk of premature ovarian insufficiency are considered when determining eligibility.
- Multidisciplinary Planning: The gynecologic surgeon works with the fertility preservation program to coordinate surgery, tissue handling, transportation, and cryopreservation.
- Laparoscopic Assessment: The pelvis, ovaries, fallopian tubes, and surrounding structures are inspected before removal.
- Ovarian Mobilization: The selected ovary is carefully mobilized while identifying the ureter and relevant vascular structures.
- Vascular Control: The ovarian blood supply is carefully sealed and divided while minimizing unnecessary thermal damage to the tissue intended for preservation.
- Unilateral Oophorectomy: One ovary is removed while preserving the contralateral ovary whenever clinically appropriate.
- Specimen Retrieval: The ovary is removed carefully, typically using a specimen retrieval bag, to avoid unnecessary trauma or contamination.
- Tissue Handling: The ovarian tissue is promptly transferred according to the fertility program’s established protocol to maintain tissue viability.
- Cryopreservation: Ovarian cortical tissue containing primordial follicles is processed and frozen for potential future transplantation or fertility treatment.
Unlike standard oophorectomy, ovarian tissue cryopreservation requires close coordination between the surgical and fertility teams to ensure that the removed tissue is handled and preserved appropriately.
What are the Risks of Unilateral Oophorectomy for Ovarian Tissue Cryopreservation?
The surgical risks are similar to those of laparoscopic oophorectomy, with additional considerations related to future ovarian function and the suitability of the preserved tissue.
- Bleeding: Division of the ovarian blood supply can result in bleeding that may require additional surgical control.
- Injury to the Remaining Ovary: Damage to the contralateral ovary could further reduce ovarian reserve and future reproductive potential.
- Ureteral Injury: The ureter travels near the ovarian blood supply and can be injured during dissection or vessel sealing.
- Injury to Surrounding Structures: The bowel, bladder, pelvic blood vessels, or other nearby structures may be injured during laparoscopic surgery.
- Reduced Ovarian Reserve: Removing one ovary decreases the total amount of ovarian tissue remaining in the body, although the remaining ovary can often continue to provide ovarian function.
- Tissue Processing or Storage Issues: Delays, improper handling, or technical problems during processing or cryopreservation could affect the viability of the preserved tissue.
- Future Transplantation Limitations: Cryopreserved ovarian tissue does not guarantee future fertility, and not all patients will ultimately be candidates for tissue transplantation.
- Risk of Reintroducing Disease: For certain malignancies, ovarian tissue may contain malignant cells, which can affect whether future transplantation is considered safe.
- Conversion to Open Surgery: Significant adhesions, unexpected anatomy, bleeding, or other complications may rarely require an open procedure.
- General Surgical Risks: Infection, blood clots, anesthesia-related complications, postoperative pain, and wound complications are possible.
Appropriate patient selection, coordination with a fertility preservation program, careful laparoscopic technique, and rapid tissue processing are important for minimizing surgical risks and maximizing the potential usefulness of the cryopreserved tissue.