O-071 The ovarian endometriotic cyst

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Nisolle
Keyword(s):  
Ovarian Reserve ◽  
Cyst Wall ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Childbearing Age ◽  
Excessive Bleeding ◽  
Ovarian Cortex ◽  
Ablative Surgery ◽  
Endometriotic Cyst ◽  
Combined Technique

Abstract text "The ovarian endometriotic cyst” Ovarian endometriomas affect 17 to 44% of women with endometriosis, and are often associated with pelvic pain and infertility. Patients suffering from endometriosis frequently present an already reduced ovarian reserve, assessed by AMH dosage or by antral follicular count during TVS. Pain and infertility are the main indications for endometrioma surgery which is a complex procedure as endometriosis leads to inflammation around the lesions, causing fibrosis. Three main surgical procedures have been described: the ovarian cystectomy, the endometrioma ablation or the combined technique. During the cystectomy, after ovarian mobilization and adhesions lifting, an incision of the cortex is realized to find a cleavage plane between the cyst wall and the ovarian cortex. Traction and countertraction movements are performed to carefuly dissociate the cyst from the ovarian cortex. It is crucial to handle the ovarian tissue as atraumatically as possible. With this technique, the cyst wall as well as the surrounding fibrosis are excised with the risk of oocytes removal responsible for decreased ovarian reserve. The ablative surgery is defined by the fenestration and vaporization of the endometrioma cyst. The ablation is carried out using a laser or plasma energy or electrocoagulation. Once the endometrial cyst has been emptied of its contents, the entire internal surface of the endometrioma must be sprayed or evaporated using the different chosen techniques. Where feasible, the cyst may be turned inside out to facilitate further treatment. The combined technique associates partial cystectomy (80-90%) and ablation of the 10-20% remaining endometrioma. This method is especially useful while operating large endometriomas. It prevents excessive bleeding or damage to the ovarian tissue. In cases of large ovarian endometrioma, the three-step approach has been proposed, consisting on an opening and drainage of the cyst followed by a 3 months’ administration of Gn-RH agonists in order to reduce its diameter and vascularization. A second surgical procedure is then scheduled to ablate the remaining cyst wall. In conclusion, it is crucial to keep in mind that endometriosis and especially the presence of endometrioma reduce fertility whereas in the majority of cases, the ovarian reserve is already diminished in relation to the patient's age. Ovarian preservation must be one of our priorities in young patients of childbearing age and it is therefore really important to carry out surgeries that are as atraumatic as possible. Trial registration number: Study funding: Funding source:

scholarly journals 203 ASSESSMENT OF OVARIAN RESERVE. IS THERE A ROLE FOR OVARIAN BIOPSY?

2005 ◽  
Vol 17 (2) ◽  
pp. 252
Author(s):  
R. De Roover ◽  
C. Hanzen
Keyword(s):  
Ovarian Reserve ◽  
Ovarian Tissue ◽  
Primordial Follicles ◽  
Ovarian Cortex ◽  
Human Fertility ◽  
Multiple Biopsies ◽  
Size And Morphology ◽  
Blind Sampling ◽  
Small Parts

The pool of primordial follicles in the ovary or ovarian reserve is a major factor in human fertility potential. In bovine medicine as well, this ovarian reserve has been linked to the results of superovulation procedures (Cushman et al. 1999 Biol. Reprod. 60, 349–354). These authors suggested a biopsy to assess the level of this reserve. Whether the biopsy(ies) is(are) a true reflection of the follicular distribution in the ovarian cortex, is (to the best of our knowledge) a factor never investigated until now in bovine medicine. In human medicine, this procedure has been critically examined for that particular use and found not to be suited (Lass et al. 2004 Hum. Reprod. 19, 467–469). Indeed, randomized or “blind” sampling of one biopsy is adequate only if follicles are evenly spread in the ovarian cortex; in any case they are not deeper than a few mm from the surface. Moreover, the quantitative counting of follicles does not provide any information about the quality of the oocytes embedded in them. Taking a biopsy of a bovine ovary in a minimally invasive way is technically feasible (Aerts 2004 Reprod. Fertil. Dev. 16, 229–230). Therefore, the aim of this study was to examine the natural distribution of primordial follicles in the ovarian cortex of bovine ovaries. Slaugtherhouse ovaries were collected at random. The volume (mL) was measured and the macroscopically visible follicles were counted. Then the ovaries were cut in slices of 5Âμm, and every 8th (8 × 5 = 40 μm interval) slice was subjected to fixation in formalin and hematoxylin-eosin staining. Before counting of the primordial follicles, the ovarian cortex was subdivided into 8 equal parts. These “parts” were supposed to mimick a (single) ovarian biopsy. The 8 parts of a slice represent here multiple biopsies. For each of these parts, the number of primordial follicles was counted; only follicles with a visible oocyte were included. The results of the parts containing the ligament of the ovary were excluded. Results are shown in Table 1. The results show that the distribution of primordial follicles between small parts of the bovine ovarian tissue was extremely uneven. A large variation was observed between samples obtained from the same ovary. Moreover, an extrapolation of follicle numbers found in biopsies to entire ovaries were hampered by the uneven size and morphology of these ovaries. Therefore, we conclude that the use of single biopsies of ovarian cortex for a quantitative evaluation of the ovarian reserve has limited value; an empty cortex or a cortex with very few follicles might be just incidental and meaningless. Even the use of multiple biopsies, although less variable, does not solve the problem of extrapolation of these data to entire ovaries. Table 1. Macroscopically visible follicles on 4 ovaries and primordial (“microscopical”) follicles on 4 slices of each of these ovaries

Excision of endometriotic cyst wall may cause loss of functional ovarian tissue

2006 ◽  
Vol 85 (3) ◽  
pp. 758-760 ◽  
Author(s):  
Umut Dilek ◽  
Ozlem Pata ◽  
Canten Tataroglu ◽  
Meral Aban ◽  
Saffet Dilek
Keyword(s):  
Cyst Wall ◽  
Ovarian Tissue ◽  
Endometriotic Cyst

scholarly journals Ovarian follicles of young patients with Turner’s syndrome contain normal oocytes but monosomic 45,X granulosa cells

2019 ◽  
Vol 34 (9) ◽  
pp. 1686-1696 ◽  
Author(s):  
Ronald Peek ◽  
Myra Schleedoorn ◽  
Dominique Smeets ◽  
Guillaume van de Zande ◽  
Freek Groenman ◽  
...  
Keyword(s):  
X Chromosome ◽  
Granulosa Cells ◽  
Stromal Cells ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Ovarian Follicles ◽  
Buccal Cells ◽  
Ovarian Cortex ◽  
Ovarian Cells ◽  
High Level

Abstract STUDY QUESTION What is the X chromosomal content of oocytes and granulosa cells of primordial/primary (small) follicles and stromal cells in ovaries of young patients with Turner’s syndrome (TS)? SUMMARY ANSWER Small ovarian follicles were detected in one-half of the patients studied, and X chromosome analysis revealed that most oocytes were normal, granulosa cells were largely monosomic, while stromal cells showed a high level of mosaicism. WHAT IS KNOWN ALREADY Most women with TS experience a premature reduction or complete loss of fertility due to an accelerated loss of gametes. To determine whether fertility preservation in this group of patients is feasible, there is a strong need for information on the X chromosomal content of ovarian follicular and stromal cells. STUDY DESIGN, SIZE, DURATION Small follicles (<50 μm) and stromal cells were isolated from ovarian tissue of young TS patients and analysed for their X chromosomal content. In addition to ovarian cells, several other cell types from the same patients were analysed. PARTICIPANTS/MATERIALS, SETTING, METHODS After unilateral ovariectomy, ovarian cortex tissue was obtained from 10 TS patients (aged 2–18 years) with numerical abnormalities of the X chromosome. Ovarian cortex fragments were prepared and cryopreserved. One fragment from each patient was thawed and enzymatically digested to obtain stromal cells and primordial/primary follicles. Stromal cells, granulosa cells and oocytes were analysed by FISH using an X chromosome-specific probe. Extra-ovarian cells (lymphocytes, buccal cells and urine cells) of the same patients were also analysed by FISH. Ovarian tissue used as control was obtained from individuals undergoing oophorectomy as part of their gender affirming surgery. MAIN RESULTS AND THE ROLE OF CHANCE Ovarian follicles were detected in 5 of the 10 patients studied. A method was developed to determine the X chromosomal content of meiosis I arrested oocytes from small follicles. This revealed that 42 of the 46 oocytes (91%) that were analysed had a normal X chromosomal content. Granulosa cells were largely 45,X but showed different levels of X chromosome mosaicism between patients and between follicles of the same patient. Despite the presence of a low percentage (10–45%) of 46,XX ovarian cortex stromal cells, normal macroscopic ovarian morphology was observed. The level of mosaicism in lymphocytes, buccal cells or urine-derived cells was not predictive for mosaicism in ovarian cells. LIMITATIONS, REASONS FOR CAUTION The results are based on a small number (n = 5) of TS patient samples but provide evidence that the majority of oocytes have a normal X chromosomal content and that follicles from the same patient can differ with respect to the level of mosaicism of their granulosa cells. The functional consequences of these observations require further investigation. WIDER IMPLICATIONS OF THE FINDINGS The results indicate that despite normal ovarian and follicular morphology, stromal cells and granulosa cells of small follicles in patients with TS may display a high level of mosaicism. Furthermore, the level of mosaicism in ovarian cells cannot be predicted from the analysis of extra-ovarian tissue. These findings should be considered by physicians when offering cryopreservation of ovarian tissue as an option for fertility preservation in young TS patients. STUDY FUNDING/COMPETING INTEREST(S) Unconditional funding was received from Merck B.V. The Netherlands (Number A16-1395) and the foundation ‘Radboud Oncologie Fonds’ (Number KUN 00007682). The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER NCT03381300.

O-191 Assessing the use of tumour-specific DARPin-toxin fusion proteins for ex vivo purging of cancer metastases from human ovarian cortex tissue fragments before autotransplantation

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L Eijkenboom ◽  
V Palacio-Castañeda ◽  
F A Groenman ◽  
D D M Braat ◽  
C C M Beerendonk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Cells ◽  
Fusion Proteins ◽  
Breast Cancer Cells ◽  
Ex Vivo ◽  
Ovarian Tissue ◽  
In Vitro Growth ◽  
Ovarian Cortex ◽  
Positive Breast Cancer

Abstract Study question Is it possible to eradicate cancer cells from ovarian cortex by using tumour-specific designed ankyrin repeat protein (DARPin)-toxin fusion proteins, without compromising the ovarian tissue? Summary answer Purging ovarian cortex ex vivo from experimentally induced breast cancer tumour foci is possible by tumour-targeted DARPin-toxin fusion proteins trough inhibition of protein synthesis. What is known already Ovarian tissue cryopreservation and autotransplantation is a successful technique for fertility restoration in cancer patients. The procedure is not without risk since malignant cells may still be present in the graft. Procedures to detect cancer cells render the tissue fragment useless for autotransplantation. Strategies to circumvent this problem such as in vitro maturation of follicles or the construction of artificial ovaries are pursued but are still experimental. Alternatively, we have shown ex vivo purging of ovarian cortex is possible by elimination of rhabdomyosarcoma after treatment with verteporfin. This allows treatment of cortex fragments before autotransplantation without compromising ovarian tissue integrity. Study design, size, duration Human ovarian cortex fragments harbouring breast cancer tumour foci were exposed for 24 h to DARPins fused to the translocation and catalytic domain of Pseudomonas aeruginosa exotoxin A (DARPin-toxin fusion proteins) targeting EpCAM or HER2. After treatment with the DARPin-toxin fusion proteins the tissue was cultured for an additional 6 days to allow any remaining tumour cells to form foci. In addition, the functional integrity of the ovarian tissue was analysed after purging. Participants/materials, setting, methods Breast cancer cell lines expressing different levels of EpCAM and HER2 were introduced in human ovarian tissue to form tumour foci. After purging with DARPin-toxin fusion proteins, the presence of any remaining cancer cells in the tissue was analysed with (immuno)histochemistry and RT-qPCR. Possible detrimental effects on the viability of ovarian cortex and follicles were determined by (immuno)histology, a follicular viability assay and an assay to determine the in vitro growth capacity of small follicles. Main results and the role of chance Ovarian cortex harbouring EpCAM-positive breast cancer cells showed a significant decrease in the number of tumour foci after treatment with the EpCAM-targeted DARPin-toxin fusion proteins. Although exposure to the EpCAM-specific DARPin had no effect on morphology or viability of follicles, a decrease in oocyte viability after in vitro growth experiments was observed, presumably due to low level expression of EpCAM on oocytes. In contrast to the EpCAM-specific DARPin-toxin fusion protein, the DARPin-toxin fusion protein targeting HER2 had no detrimental effects on morphology, viability or in vitro growth of follicles while foci of HER2-positive breast cancer cells were severely affected as indicated by the presence of apoptotic bodies, tumour cell remnants and the absence of viable tumour cells. The histological results after purging with the HER2-specific DARPin-toxin fusions proteins were confirmed by RT-qPCR, showing a decrease to basal levels of HER2 mRNA in the ovarian cortex tissue. Limitations, reasons for caution The effect of DARPin-toxin fusion proteins depends heavily on the expression of their target on the cancer cell. The target protein should not be expressed by ovarian cortex as this may lead to tissue damage. The functional integrity of ovarian cortex after the treatment requires further investigation in vivo. Wider implications of the findings Purging metastases from ovarian cortex without harming ovarian tissue is possible by targeting tumour specific surface expressed antigens with DARPin-toxin fusion proteins. Purging ovarian cortex tissue with DARPin-toxin fusion proteins provides a feasible therapeutic strategy to prevent reintroduction of cancer by autotransplantation in case of malignancies expressing tumour-specific surface markers. Trial registration number not applicable

Endometriosis of the perianal region – epidemiology, diagnosis and treatment

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (4) ◽  
Author(s):  
Małgorzata Kołodziejczak ◽  
Iwona Sudoł-Szopińska ◽  
Małgorzata Siergiej
Keyword(s):  
Conservative Treatment ◽  
Histopathological Examination ◽  
Transvaginal Ultrasound ◽  
Young Patients ◽  
Pain Syndrome ◽  
Cervix Uteri ◽  
Pelvic Pain Syndrome ◽  
Hormonal Activity ◽  
Childbearing Age ◽  
Extensive Resection

Endometriosis is the presence of the uterine endometrium beyond the uterus. The disease usually affects women of childbearing age. Foci of endometriosis are mostly (in 95% of cases) located in the peritoneal cavity (cervix uteri, vaginal vault, vulva, urinary bladder, inguinofemoral region) and only rarely found beyond it. Occasionally, endometriosis is found in the perineal tissues, usually in the episiotomy scar, and, exceptionally rarely, in the anorectal region. Endometriosis usually develops in the period of hormonal activity. The disease may be asymptomatic or manifest with dyspareunia, pelvic pain syndrome, fertility problems, menstrual disorders and heavy menstruation. The diagnosis of anorectal endometriosis is established through a thorough interview and additional tests, including transrectal and transvaginal ultrasound or optionally magnetic resonance imaging. The final diagnosis is determined in a histopathological examination, usually of samples collected intraoperatively. Also, an endoscopic examination should be performed (at least rectoscopy) to rule out other pathological lesions. Treatment includes pharmacotherapy and surgery. In young patients, in the period of hormonal activity, extensive resection with primary sphincter reconstruction seems to be the most optimal option. In older patients, nearing menopause, conservative treatment is a better solution as endometriosis regresses and disease symptoms subside after menopause. In these cases, conservative treatment helps avoid iatrogenic sphincter injury and faecal incontinence.

scholarly journals Functional Ovarian Reserve in Women With Infertility and Euthyroidism: What Is the Role of Thyroid Autoimmunity?

2021 ◽  
Author(s):  
Diana Festas Silva ◽  
Tânia Carvalho ◽  
Leonor Gomes ◽  
Isabel Paiva ◽  
Paulo Cortesão ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Polycystic Ovary ◽  
Thyroid Autoimmunity ◽  
Univariate Analysis ◽  
Human Reproduction ◽  
Thyroid Peroxidase ◽  
Childbearing Age ◽  
Autoimmune Pathology ◽  
Cervical Surgery ◽  
Tsh Levels

Abstract Background: Thyroid dysfunction is the most common endocrine disorder in women of childbearing age, and is associated with menstrual irregularities, anovulation and infertility. Whether it is thyroid function, thyroid autoimmunity (AI) or both that affects functional ovarian reserve remains to be clarified. The aim of this study was to evaluate the association between functional ovarian reserve and thyroid AI in women with infertility in euthyroidism.Methods: retrospective study of women with infertility, in euthyroidism, followed in a Human Reproduction Department, between May 2016 and January 2020. TSH, anti-thyroid peroxidase (TPO) antibodies, anti-thyroglobulin (TG) antibodies were measured. Functional ovarian reserve was assessed by anti-Müllerian hormone (AMH) levels with antral follicle count (AFC) performed by endovaginal ultrasound. Women with at least one of the following criteria were excluded: prior thyroidectomy, radioactive iodine treatment, cervical surgery/radiotherapy, oophorectomy, malignant/autoimmune pathology, chronic kidney disease, liver disease, polycystic ovary syndrome, current pregnancy and current medication with levothyroxine, methimazole or propylthiouracil. Results with p<0.05 were considered statistically significant.Results: 730 women were evaluated, with mean age of 34.9±3.9 years, with positive thyroid AI (≥ 1 positive antibody) present in 14.8% of cases. Anti-TPO antibodies were positive in 11.0% of patients and anti-TG antibodies in 7.0%. Mean TSH level was 1.6±0.7 µIU/mL (NR: 0.4-4.0). Median body mass index (BMI) was 22.8 kg/m2 (IQR 5.1). Median AMH was 1.7ng/mL (IQR 2.1), and mean AFC was 10.2±6.3. Patients with positive and negative thyroid AI did not differ significantly with age (p=0.133), BMI (p=0.784], AFC (p=0.508) and AMH (p=0.825). TSH levels were significantly higher in the positive AI group (2.0±0.8 vs 1.5±0.7µIU/mL; p<0.001).In the univariate and multivariate analysis, only patient's age and AFC were predictive of AMH levels (p<0.001; p<0.001, respectively). TSH levels, BMI and thyroid AI were not predictive of AMH levels.In regard to AFC, in the univariate analysis, only age was predictive (p<0.001). TSH levels, BMI and thyroid AI were not predictive of AFC.Conclusions: In this study we found that thyroid autoimmunity, in women with infertility and TSH levels in the normal range, apparently, do not have a predictive role for functional ovarian reserve.

scholarly journals Administration of DHEA augments progesterone production in a woman with low ovarian reserve being transplanted with cryopreserved ovarian tissue

2014 ◽  
Vol 31 (6) ◽  
pp. 645-649 ◽  
Author(s):  
Susanne Strauss ◽  
Tine Greve ◽  
Erik Ernst ◽  
Matthiaos Fraidakis ◽  
Jurgis Gedis Grudzinskas ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Ovarian Tissue ◽  
Progesterone Production ◽  
Cryopreserved Ovarian Tissue

scholarly journals Young patients with diminished ovarian reserve undergoing assisted reproductive treatments: a preliminary report

2005 ◽  
Vol 11 (3) ◽  
pp. 294-299 ◽  
Author(s):  
Banu Kumbak ◽  
Engin Oral ◽  
Semra Kahraman ◽  
Guvenc Karlikaya ◽  
Hale Karagozoglu
Keyword(s):  
Ovarian Reserve ◽  
Preliminary Report ◽  
Young Patients ◽  
Diminished Ovarian Reserve

O-180 Oocyte vitrification for fertility preservation does not delay the initiation of neoadjuvant chemotherapy for breast cancer

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
I Sellami ◽  
M Grynberg ◽  
A Benoit ◽  
C Sifer ◽  
A Mayeur ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Diagnosis ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Oocyte Retrieval ◽  
Breast Cancer Patients ◽  
Oocyte Vitrification

Abstract Study question Does oocyte vitrification for fertility preservation (FP) delay the initiation of neoadjuvant chemotherapy for breast cancer? Summary answer The indication of neoadjuvant chemotherapy for breast cancer should not be considered as an impediment to urgent oocyte vitrification for FP. What is known already FP is considered as one of the most important issues to address for young breast cancer patients. Cryopreservation of oocytes or embryos may be considered after controlled ovarian hyperstimulation (COH) or in vitro maturation (IVM). Pregnancies have been reported after reutilization of oocytes frozen following both procedures. Although oocyte competence is better after COH, this strategy requires on average 13 days to be achieved. In addition, the safety of ovarian stimulation before tumor removal is currently not formally established. In case of neoadjuvant chemotherapy, the risk-benefit balance of COH is not well known. Study design, size, duration Retrospective cohort study including all breast cancer patients eligible for oocyte vitrification following COH or IVM before initiation of neoadjuvant chemotherapy between January 2016 and December 2020. Participants/materials, setting, methods Inclusion criteria were: female patients with confirmed non metastatic breast cancer, 18 to 40 years of age, with indication of neoadjuvant chemotherapy, who have had oocyte retrieval for FP after COH or IVM +/- cryopreservation of ovarian tissue. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. Main results and the role of chance A total of 198 patients with confirmed breast cancer who had oocyte retrieval following COH (n = 57) or IVM +/- cryopreservation of ovarian tissue (n = 141) for FP prior to neoadjuvant chemotherapy were included. Although women in IVM group were significantly younger as compared to patients who underwent COH (31.7 ± 4.2 vs. 33.3 ± 4.0 years, p = 0.019), ovarian reserve parameters, BMI and cancer stage did not differ between the two groups. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COH or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36.9 ±13.5 days in COH and IVM groups respectively, p=0.857). Limitations, reasons for caution The time from referral to FP consultation may have influenced the type of FP. In addition, the retrospective nature of the present analysis may constitute a limitation. Moreover, the efficiency and security of the different FP strategies used has not been analysed. Wider implications of the findings Oocyte vitrification following COH or IVM was not associated with delayed breast cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Young patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. Trial registration number Not applicable

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