Ovarian transplantation appears to restore ovulatory function robustly. Successful pregnancies, including one after cryopreservation, bode well for application to fertility preservation.

Monozygotic 24-year-old twins presented with discordant ovarian function. One had had premature ovarian failure at the age of 14 years, whereas her sister had normal ovaries and three naturally conceived children. After unsuccessful egg-donation therapy, the sterile twin received a transplant of ovarian cortical tissue from her sister by means of a minilaparotomy. Within three months after transplantation, the recipient's cycles resumed and serum gonadotropin levels fell to the normal range. During the second cycle, she conceived, and her pregnancy progressed uneventfully. At 38 weeks' gestation, she delivered a healthy-appearing female infant.

No abstract

Ovary cryopreservation and transplantation has garnered increasing interest as a possible method to preserve fertility for cancer patients and to study ovarian resting follicle recruitment. Eleven consecutive women underwent fresh donor ovary transplantation, and 11 underwent cryopreserved ovary auto-transplantation in the same centre, with the same surgeon. Of the 11 fresh transplant recipients, who were all young but menopausal, nine women had normal ovarian cortex transplanted from an identical twin sister, and two had a fresh allograft from a non-identical sister. In the second group, 11 women with cancer had ovarian tissue cryopreserved before bone marrow transplant, and then after years of therapeutically induced menopause, underwent cryopreserved ovarian cortex autotransplantation. Recovery of ovarian function and follicle recruitment was assessed in all 22 recipients, and the potential for pregnancy was further investigated in 19 (11 fresh and 8 cryopreserved) with over 1-year follow-up. In all recipients, normal FSH levels and menstruation returned by about 150 days, and anti-Müllerian hormone reached much greater than normal concentrations by about 170 days. Anti-Müllerian hormone levels then fell below normal by about 240 days and remained at that lower level. Seventeen babies have been born to these 11 fresh and eight cryopreserved ovary transplant recipients.

From January 1998 through August, 2001, 108 women with a preoperative diagnosis of suspected ovarian dermoid cyst underwent surgical treatment at the University of Miami. Fifty-three patients underwent laparoscopic cystectomy (n ϭ 32, 61%) or laparoscopic oophorectomy (n ϭ 21, 39%) and another 55 patients had laparotomy for ovarian cystectomy or oophorectomy.Laparoscopy was performed using three or four trocars, at least one of which was placed at the umbilicus. During laparoscopic cystectomy, after separation from the ovary, the cyst was placed into an impermeable bag. The bag was removed using the largest trocar port. When the opening of the bag was completely out of the port, the contents of the cysts were drained in the bag before complete removal. If spillage occurred, lavage of the peritoneal cavity was performed until the irrigation was clear.The mean age of patients was significantly lower (27.6 years; range, 7-46 years) for the 55 women who underwent laparotomy compared with those who had laparoscopy (33.5 years; range, 19-55 years) (P Ͻ0.001). Otherwise, the two groups were comparable. Chronic pain was the most common presenting complaint (69%). Four patients presented with acute pelvic pain and 22% of patients had no symptoms. Nearly one third of patients had more than one presenting symptom.Dermoid cysts tended to be larger in women who had laparotomy (mean cyst diameter 9.75 cm) compared with the women who underwent laparoscopy (mean cyst diameter 6.52 cm) (P ϭ 0.007). Fourteen percent of the patients had bilateral cysts. Spillage of the cyst contents was much more frequent in women who underwent laparoscopy (31.4%) compared with those who had laparotomy (4.1%) (P ϭ 0.0004). The mean operating room time was significantly less for laparotomy procedures than for laparoscopy (88 minutes vs 118 minutes) (P ϭ 0.0008), but mean blood loss was greater in laparotomy procedures compared with laparoscopy (119 mL and 72 mL, respectively; P ϭ 0.002).Intraoperative laparoscopy complications included uterine perforation in two women, enterotomy in one patient, and cystotomy in one laparotomy patient. There were more postoperative complications in laparotomy patients (n ϭ 8) than in the laparoscopic group (n ϭ 2). In the laparoscopic group, one patient had a postoperative wound infection and one woman developed a hernia. Among laparotomy patients, there were four postoperative wound infections, one urinary tract infection, two postoperative fevers, and one death. The woman who died was obese with a 24-cm partially infracted dermoid cyst and died the day after surgery of cardiac arrhythmia. Nine (17%) patients undergoing laparoscopy were converted to laparotomy, four because of the large size of the mass and five as a result of adhesions. Nine patients with pain and cyst torsion underwent laparotomy.Laparoscopy was significantly more commonly associated with dermoid cyst spillage, even when adjustments were made for cyst size, oophorectomy, and cystectomy. No patient in this series developed peritonitis. EDITORIAL C...