AUTOTRANSPLANTATION OF CRYOPRESERVED OVARY AND PROBLEMS OF ITS REPERFUSION

The rising incidence of oncological diseases among young people is now observed in Russia. As of 2015, among all 290 707 newly revealed oncological diseases in female patients, 23 000 accrued for women of reproductive age (data of A.F. Tsyba Medical Radiological Scientific Center). Results of anticancer treatment in fertile women improve. However, chemotherapy is often accompanied by the significant gonadotoxic action, which manifests itself in premature menopause, that is, loss of fertility (sterility) and sharp decrease in the quality of life due to premature ageing of organism. Ways to restore the fertility of young female patients after anticancer treatment are now actively searched for. High expectations were laid on orthotopic autotransplantation of cryopreserved ovarian tissue - ovarian cortical layer after unilateral adnexectomy before chemotherapy courses. Once the treatment of a female patient was accomplished, three to four 1-mm thick 10.5 mm plates of the vitrified cortical layer were transported by laparoscopy into the pelvic cavity and fixed by interrupted suture to the albugineous tunic of the anterior surface of the rest afunctional ovary. Unfortunately, this method fell short of high hopes (small number of pregnancies after IVF), which were laid on it by gynecologic oncologists and their young female patients. Causes: 1) neovasculogenesis in transplanted cortical plates is ineffective owing to the well-known specificity of their blood supply by vessels of ovarian medulla and their frequent lysis; 2) the transplanted tissues contain no functioning ovarian medulla, whose hormones are responsible for maturation of fertile ovum; 3) there are no homologs of male genital organs (epoophoron, paroophoron, rete ovarii, Malpighi-Gartner duct) playing an important functional role in full-featured reproductive function in women. All of this necessitates the development of a new technology for ortho- and heterotopic autotransplantation of a defrosted whole ovary with a vascular pedicle and homologs of male genital organs with their immediate inclusion into the blood circulation of neighboring recipient vessels. Anatomy of the ovarian system was studied from the viewpoint of organ transplantology (54 samples of internal female genital organs of dead women aged from 20 to 50). Three points of ovary fixation were verified: ovarian ligament, infundibulopelvic ligament, mesoovarium. Blood supply of ovary along with homologs of male genital organs is mainly provided by ovarian vessels. The outer diameter of the ovarian artery in the vascular pedicle of the ovarian system was from 0.5 to 2.0 mm, and that of the ovarian vein was up to 3.0 mm. Functional features (temperature homeostasis) of potential zones for the orthotopic and heterotopic autotransplantation of the ovarian system were studied in 86 volunteer women aged from 18 to 33. It was shown that, among all studied potential recipient zones for microsurgical autotransplantation of the ovarian system, fossa ovarica and fatty tissue (under Thomson fascia) on the anterior wall of the abdominal canal were the best. Reperfusion of the ovarian system assumed the search for neighboring recipient for immediate microvascular anastomosis. The main criterion for selection of recipient vessels was the “correspondence index.” The technology of orthotopic microsurgical autotransplantation of defrosted ovarian systems assumes the use of endoscopic surgery or minilaparotomy for removal of the rest afunctional ovary, autograft fixation according to three fixation points in fossa ovarica and inclusion into blood circulation of recipient ovarian vessels. Heterotopic autotransplantation is transplantation of the ovarian system onto the anterior wall of the abdominal canal and inclusion into the blood circulation of low epigastric vessels (deep branch) or vessels surrounding the iliac wing.

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