Relocation of the ovaries

Detailed information and a list of references can be found in Chapter 3.6 of the FertiPROTEKT book, "Indications and fertility preservation methods for oncological and non-oncological disorders", which can be downloaded free of charge.

Background

The aim of relocating the ovaries (transposition of the ovaries) is to retain their function despite planned radiotherapy. The goals are preservation of hormone production and the possibility of pregnancy after oncological treatment.

The effects of radiotherapy on the ovarian function can be extensive. Since these effects are significantly determined by the distance between the ovaries and the irradiation field as well as the dose of radiotherapy, transposition is useful when targeted radiotherapy (not total body irradiation!) is planned in the pelvic area.

The extent of damage to the ovaries by radiotherapy can be well assessed by measurement of Anti-Müllerian Hormone (AMH). Whether bilateral or unilateral relocation takes place is decided individually and mainly depends on the expected damage.

Efficacy

The results of ovarian relocation prior to radiotherapy depend on various factors and are difficult to classify. In a large overview study, an average success rate (= preserved ovarian function) of 80% was found. However, the results of individual studies vary between 17% and 95%. As well as the patient’s age, another influencing factor is the additional use of chemotherapy.

Sufficiently high positioning of the ovary after surgical relocation is critical as only about 10% of the radiation dose is effective at a distance of 10 cm away from the irradiation field. Precise coordination between the surgeon and the radiologist before the planned transposition is also important.

Overall, ovarian transposition has a great effect of on the preservation of ovarian function. On the other hand, pregnancies after radiotherapy are not very common. There are various reasons for this, such as a change in future plans after recovery or avoidance of artificial insemination, which is often necessary. Irradiation of the uterus can also reduce the chances of pregnancy.

Risks

The surgical risks of ovarian relocation are considered to be low. In most cases the procedure is possible using laparoscopy. The formation of metastases in the relocated ovaries is generally rare and dependent on the particular disease.

Costs

The costs of ovarian relocation alone are similar to those of a laparoscopy under general anaesthesia and are often not covered by health insurance. If the procedure is performed as part of another procedure, such as lymph node removal, no additional costs usually arise.