Heterotopic autotransplantation of the ovary with microvascular anastomosis: a novel surgical technique

Objective: To test the feasibility of transplanting an entire ovary with anastomosis of the ovarian vascular pedicle. Design: Long-term survival study. Setting: Biological Resources Unit, Cleveland Clinic Foundation. Animal(s): Five adult, nonpregnant ewes. Intervention(s): Laparoscopic bilateral oophorectomy was performed. Ovaries were autotransplanted into the abdominal wall, and microsurgical vascular anastomosis of the ovarian to the inferior epigastric vessels was performed. The transplant was removed and evaluated after 7 ± 1 days. Main Outcome Measure(s): Blood flow, serum E 2 and FSH levels, and histologic characteristics. Result(s): At follow-up three transplants were viable; they showed no signs of necrosis, and patency of the vascular anastomosis was confirmed. Serum E 2 levels did not change significantly after transplantation in the patent vessel group (155.3 ± 46.1 vs. 125.7 ± 44.6 pg/mL) or the nonpatent vessel group (99 vs. 158 pg/mL). Serum FSH level in the patent vessel group did not change significantly from before to after transplantation (70.6 ± 37.2 ng/mL vs. 95.1 ± 17.7 ng/mL), whereas a large increase in FSH level was observed in the nonpatent vessel group (52.3 ng/mL vs. 522 ng/mL). The patent vessel group had significantly more follicles after transplantation than did the nonpatent vessel group (6 ± 1 vs. 1 ± 1). Conclusion(s): In conjunction with improved protocols for cryopreservation, ovarian autotransplantation with vascular anastomosis may be superior to current ovarian tissue banking and grafting techniques.