In the first publication from the U.S. on surgical techniques and outcomes of single ovary removal for fertility preservation in girls, surgeons from Ann & Robert H. Lurie Children's Hospital of Chicago report that the procedure caused no complications and can be performed laparoscopically, on an outpatient basis, without delaying treatment for cancer or other therapies posing high risk of infertility. They present experience with 64 girls, aged 12 years on average, with the youngest only 5 months old at the time of surgery. Their findings were published in the Journal of Pediatric Surgery.
"We describe the unique technical nuances of removing a tiny ovary without damaging it, since it needs to be preserved in the purest form for future transplantation when the patient is ready to pursue pregnancy," says lead author Erin Rowell, MD, Director of the Fertility and Hormone Preservation and Restoration Program at Lurie Children's and Associate Professor of Surgery at Northwestern University Feinberg School of Medicine.
To preserve future fertility potential, the removed ovarian tissue is frozen – a process called cryopreservation. When a woman is ready to have a child, one of the current options is to implant the preserved tissue onto the remaining ovary, where it starts to function normally and enables natural pregnancy. Or, the oocytes (immature eggs) in the ovary may be matured into eggs for in-vitro fertilization. These techniques are considered experimental. To date, over 130 live births have been documented in adult women who have undergone ovarian tissue cryopreservation. In the U.S., women who have had ovarian tissue cryopreservation as girls have yet to give birth, although two cases have been reported in Europe.
"Through our ongoing research, we are working on setting new surgical standards and developing innovative techniques for removing, preserving and transplanting cryopreserved tissue," says Dr. Rowell.
The Fertility and Hormone Preservation and Restoration Program at Lurie Children's is the only one of its kind for pediatric patients in Illinois. Children with a variety of cancer, genetic, endocrine and rheumatologic conditions may be candidates for fertility preservation.
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This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Center for Translational Research in Reproduction and Infertility grant.
Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through the Stanley Manne Children's Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children's is ranked as one of the nation's top children's hospitals in the U.S.News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 208,000 children from 50 states and 58 countries.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.06.005
