Ovary and uterus transplantation

Abstract

Ovarian and uterine transplantation are procedures gaining more attention again because of potential applications in respectively fertility preservation for cancer and other patients and, more tentatively, women with uterine agenesis or hysterectomy. Cryopreservation of tissue slices, and possibly whole organs, is providing opportunities for banking ovaries for indefinite periods before transplanting them back to restore fertility. The natural plasticity of this organ facilitates grafting to different sites where they can be revascularized and rapidly restore the normal physiology of secretion and ovulation. Ischemic damage is a chief limitation because many follicles are lost, at least in avascular grafts, and functional longevity is reduced. Nevertheless, grafts of young ovarian tissue, even after cryopreservation, can be highly fertile in laboratory rodents and, in humans, autografts have functioned for up to 3 years before needing replacement. Transplantation by vascular anastomosis provides potentially longer function but it is technically much more demanding and riskier for the recipient. It is the only practicable method with the uterus, and has enabled successful pregnancies in several species, but not yet in humans. Contrary to claims made many years ago, neither organ is privileged immunologically, and allografts become rapidly rejected except in hosts whose immune system is deficient or suppressed pharmacologically. All in all, transplantation of these organs, especially the ovary, provides a broad platform of opportunities for research and new applications in reproductive medicine and conservation biology.

Follicle growth and oocyte development after ovary transplantation into back muscle of immune-intact adult castrated male mice

“…If the donor and host were genetically unrelated and the host's immune system was competent, there was a heavy infiltration of leucocytes within a week that quickly rejected the grafts. Immunotolerance was also not induced between mouse strains (Gosden 2007(Gosden , 2008. So far, in order to facilitate these experiments, most studies have used immunodeficient or inbred mice as recipients to reduce/eliminate rejection after ovarian transplantation (Candy et al 2000, Hosoe et al 2008, Schubert et al 2008, Soleimani et al 2008, Abir et al 2009, Motohashi et al 2009).…”

Gene expression profile of rat ovarian tissue following xenotransplantation into immune-deficient mice

“…Furthermore, genes involved in inflammatory and immune response were upregulated. However, it is intriguing to observe the experimental studies which demonstrated that the XT ovarian tissues collected from a wide array of mammalian species are capable of producing steroid hormones that maintain estrous cycles, form antral follicles (Gosden 2008), and in some cases develop into cleavage stage embryos after IVF (Senbon et al 2005).…”

Robert T. Morris, M.D.—appreciation of an enlightened surgeon and pioneer of ovarian transplantation

“…Although he sometimes used model species, as a clinical investigator he was far more constrained than animal physiologists who could incorporate controls into their experiments. Nevertheless, he was able to conclude from his case series that the ovary is an organ of ''internal secretion,'' and he became a zealot for the emerging science of endocrinology, a founder member of During the past 2 decades the annual number of original articles reporting ovarian transplantation has risen steeply from close to zero (12). Gosden the Endocrine Society, and an early proponent of endocrine therapy, which his work had anticipated.…”