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.