Department of Obstetrics and Gynecology, Eulji University School of Medicine, 2801 Hagye-dong, Nowon-gu, Seoul, South Korea. e-mail: medssk{at}attglobal.net
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Abstract |
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Key words: cancer/cryopreservation/fertility preservation/ovarian tissue/transplantation
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Introduction |
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Why should we offer ovarian banking to women and children with cancer? |
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An emerging strategy, ovarian tissue banking, can store thousands of immature oocytes effectively. Although restoration of fertility using banked ovarian tissue in humans has not yet been demonstrated, animal studies (Gosden et al., 1994b) as well as on going human studies, are supporting the validity of ovarian tissue banking. If we do not recommend ovarian tissue banking now, many young women with cancer will lose their chance of fertility restoration after aggressive cancer treatment. One may argue if it is ethical to expose the young woman with cancer to surgical risks of laparoscopic oophorectomy or ovarian biopsy for ovarian banking. However, the risk of bleeding and infection with oocyte retrieval in cancer patients is no less than that of laparoscopic surgery. Most importantly, ovarian tissue banking does not delay cancer treatment, unlike oocyte or embryo cryopreservation.
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How to collect ovarian tissue? |
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What is the current status of ovarian cryopreservation? |
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Is ovarian transplantation a practical strategy? |
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The main concern of autotransplantation in cancer patients is the possibility of cancer cell transmission. Although our recent study demonstrated the safety of ovarian transplantation in lymphoma patients (Kim et al., 2001b), it is not known whether ovarian transplantation is safe for women with other cancers. Indeed, autotransplantation of ovarian tissue should not be considered if there is a significant risk of ovarian metastasis. The risk of cancer cell transmission depends on the disease type, stage and the mass of malignant cells transferred. Ovarian involvement in Wilms tumour, Hodgkins lymphoma, osteosarcoma and squamous cell cervical carcinoma is very rare (Young and Scully, 1994
), but systemic and hematogeneous malignancies such as leukaemias carry a high risk of ovarian metastasis. Ovarian autotransplantation in breast cancer patients is not safe, as the frequency of ovarian metastasis during the course of breast cancer is 1338% (Gagnon and Tetu, 1989
; Perrotin et al., 2001
). The clinical application of ovarian autotransplantation will be safer and more practical if reliable screening methods to detect cancer cells in the stored ovarian tissue are developed.
Xenotransplantation can provide an alternative to autotransplantation for women with cancer. In fact, xenotransplantation can eliminate the worry of cancer cell transmission. It has been already demonstrated that grafting of ovarian tissue from cat, sheep, and monkey to immunodeficient mice could support follicular development up to the antral stage (Gosden et al., 1994a; Candy et al., 1995
). The same results were obtained by xenografting human ovarian tissue to immunodeficient mice (Weissman et al., 1999
). Furthermore, ovulatory capacity of the follicles grown in xenografts was evidenced by observing the formation of morphologically normal corpora lutea and the ovulatory concentrations of serum progesterone in host animals (Kim et al., 2002
). The ethical concerns and safety issues associated with growing human follicles to maturity in animal hosts should be resolved before the clinical application of this technique.
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What should we do for successful transplantation of ovarian tissue? |
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It could be speculated that antioxidant treatment might protect the ovarian graft from hypoxic injuries, as hypoxia induces the generation of reactive oxygen species (ROS). In fact, our unpublished study using bovine ovarian tissue showed the decrease of apoptosis in the ascorbic acid (antioxidant) treated group. Ultimately, the whole ovary transplantation by vascular anastomosis will be a solution for this problem, given that the technology to freeze the intact human ovary can be developed.
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Conclusions |
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Acknowledgement |
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References |
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