Ovarian transplant: a new frontier.

Area of Science:

• Reproductive endocrinology
• Transplantation surgery
• Genetics

Background:

• Turner syndrome (45XO) is characterized by ovarian dysgenesis, leading to primary amenorrhea, short stature, and absent secondary sexual characteristics.
• Ovarian transplantation is explored as a therapeutic option for patients with primary ovarian insufficiency.

Observation:

• Two cases of orthotopic ovarian transplantation were performed using living related donors (mother and sister) who were immunologically matched.
• The first case involved vascularized transplantation with microsurgical anastomosis of ovarian vessels to the iliac and epigastric vessels.
• The second case utilized avascular ovarian cortical grafts placed orthotopically and in the broad ligament due to lack of suitable veins for anastomosis.

Findings:

• The vascularized transplant resulted in regular menstruation, ovulation, hormonal level rise, and development of secondary sexual characteristics over 2.5 years.
• The avascular grafts showed good uptake and follicular development on imaging (USG, power-angio, MRI) with evidence of hormonal function within one month.
• Both cases were managed with immunosuppression using cyclosporine and prednisolone.

Implications:

• Orthotopic ovarian transplantation, both vascularized and avascular, demonstrates potential for restoring endocrine and reproductive function in Turner syndrome.
• These findings suggest that ovarian transplantation could be a viable strategy for managing infertility and hormonal deficiencies in patients with ovarian dysgenesis.
• Further research and larger studies are warranted to establish the long-term efficacy and safety of ovarian transplantation in Turner syndrome.