Histomorphological Aspects of the Ovarian Cortex Regarding Ovarian Reserve and Local Pelvic Inflammation

2018 ◽  
Vol 35 (1) ◽  
pp. 21-26
Author(s):  
Michio Kitajima ◽  
Naoko Murakami ◽  
Ken Taniguchi ◽  
Yuriko Kitajima ◽  
Ozora Tsukamoto ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Ovarian Cortex

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

scholarly journals In vitro activation of ovarian cortex and autologous transplantation: A novel approach to primary ovarian insufficiency and diminished ovarian reserve

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
L Devenutto ◽  
R Quintana ◽  
T Quintana
Keyword(s):  
Ovarian Reserve ◽  
Conflicts Of Interest ◽  
Autologous Transplantation ◽  
Primary Ovarian Insufficiency ◽  
Diminished Ovarian Reserve ◽  
Ovarian Insufficiency ◽  
Primordial Follicles ◽  
Ovarian Cortex ◽  
In Vitro Activation

Abstract BACKGROUND Primary ovarian insufficiency (POI) and diminished ovarian reserve are two conditions that affect women’s fertility. Oocyte donation remains an option for these patients; however, the development of certain novel technologies, such as in vitro activation of ovarian cortex (IVA), enables the possibility of activating the pool of resting primordial follicles, increasing the chance of pregnancy. OBJECTIVE AND RATIONALE Here, we review the main pathways (PI3K and Hippo signaling) that govern the activation of primordial follicles and its application through the development of culture systems that support ovarian cortex for autologous transplantation. We also review the available data from case reports regarding outcomes of pregnancy and live birth rates with IVA. SEARCH METHODS A PubMed search was conducted using the PubMed-NCBI database to identify literature pertinent to the pathways involved in the activation of primordial follicles and the outcomes of IVA techniques from 2013 to the present. OUTCOMES Women with POI have around a 5% chance of spontaneous pregnancy. Recently, novel techniques involving the activation of primordial follicles through molecular pathways have been developed, thus increasing the odds of these patients. More recently, the introduction of a drug-free IVA technique has shown to increase the number of antral follicles with successful oocyte maturation after gonadotropin treatment, reaching pregnancy rates over 30%, either through spontaneous conception or by the implementation of assisted reproductive technology. LIMITATIONS The evidence of this review is based on a few small series, so data should be interpreted with caution, and only randomized controlled trials could estimate the real magnitude and success of the procedure. REASONS FOR CAUTION IVA technique remains an experimental strategy, with limited available data and the requirement of invasive procedures. Moreover, possible carcinogenic effects not yet determined after transplantation require special caution. WIDER IMPLICATIONS In view of the results achieved, IVA could provide a promising option for the preservation of fertility in some cancer patients and prepuberal girls where the only alternative is tissue cryopreservation. STUDY FUNDING/COMPETING INTERESTS The authors received no specific funding for this work and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Impact of chemotherapy on risk of diminished ovarian reserve in premenopausal women subjected to ovarian cortex cryopreservation

Maturitas ◽  
2021 ◽  
Vol 152 ◽  
pp. 94
Author(s):  
Ester Ortiz Murillo ◽  
Juan José Hidalgo ◽  
Irene Zolfaroli ◽  
María José Vila ◽  
María Sánchez ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Premenopausal Women ◽  
Diminished Ovarian Reserve ◽  
Ovarian Cortex ◽  
Ovarian Cortex Cryopreservation

scholarly journals Single cell map of the human ovarian cortex

2019 ◽  
Author(s):  
Magdalena Wagner ◽  
Masahito Yoshihara ◽  
Iyadh Douagi ◽  
Anastasios Damdimopoulos ◽  
Sarita Panula ◽  
...  
Keyword(s):  
Stem Cells ◽  
Single Cell ◽  
Ovarian Reserve ◽  
Structural Changes ◽  
Cell Types ◽  
Germline Stem Cells ◽  
Perivascular Cells ◽  
Hormone Production ◽  
Ovarian Cortex ◽  
Outer Lining

ABSTRACTThe human ovary orchestrates sex hormone production and undergoes monthly structural changes to release mature oocytes. The outer lining of the ovary (cortex) has a key role in defining fertility in women as it harbors the ovarian reserve. It has been postulated that putative oogonial stem cells exist in the ovarian cortex and that these can be captured by DDX4 antibody isolation. We analysed on a single cell level the transcriptome and cell surface antigen profiles of over 24,000 cells from high quality ovarian cortex samples from 21 patients. Our single cell mapping reveals transcriptional profiles of six main cell types; oocytes, granulosa cells, immune cells, endothelial cells, perivascular cells, and stromal cells. Cells captured by DDX4 antibody are perivascular cells, not oogonial stem cells. Our data does not support the existence of germline stem cells in adult human ovaries thereby reinforcing the dogma of a limited ovarian reserve.

scholarly journals Single-cell analysis of human ovarian cortex identifies distinct cell populations but no oogonial stem cells

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Magdalena Wagner ◽  
Masahito Yoshihara ◽  
Iyadh Douagi ◽  
Anastasios Damdimopoulos ◽  
Sarita Panula ◽  
...  
Keyword(s):  
Stem Cells ◽  
Single Cell ◽  
Ovarian Reserve ◽  
Structural Changes ◽  
Single Cell Analysis ◽  
Cell Types ◽  
Germline Stem Cells ◽  
Perivascular Cells ◽  
Hormone Production ◽  
Ovarian Cortex

AbstractThe human ovary orchestrates sex hormone production and undergoes monthly structural changes to release mature oocytes. The outer lining of the ovary (cortex) has a key role in defining fertility in women as it harbors the ovarian reserve. It has been postulated that putative oogonial stem cells exist in the ovarian cortex and that these can be captured by DDX4 antibody isolation. Here, we report single-cell transcriptomes and cell surface antigen profiles of over 24,000 cells from high quality ovarian cortex samples from 21 patients. Our data identify transcriptional profiles of six main cell types; oocytes, granulosa cells, immune cells, endothelial cells, perivascular cells, and stromal cells. Cells captured by DDX4 antibody are perivascular cells, not oogonial stem cells. Our data do not support the existence of germline stem cells in adult human ovaries, thereby reinforcing the dogma of a limited ovarian reserve.

scholarly journals Fertility Preservation Counselling for Women With Endometriosis: A European Online Survey

2021 ◽  
Author(s):  
Nicole Sänger ◽  
Marco Menabrito ◽  
Atillio Di Spiezo Di Spiezo Sardo ◽  
Josep Estadella ◽  
Jasper Verguts
Keyword(s):  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Reproductive Medicine ◽  
Online Survey ◽  
Fertility Treatment ◽  
Deep Endometriosis ◽  
Management Guidelines ◽  
Ovarian Cortex ◽  
Current Fertility ◽  
Infertile Patients

Abstract Background: Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital are strategies to preserve fecundity. Methods: An online survey was sent to reproductive specialists and gynaecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients. Results: Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis. Conclusions: To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.

Serum AMH concentration has limited prognostic value for the density of primordial follicles questioning AMH as a parameter for the real ovarian reserve

2018 ◽  
Author(s):  
J Liebenthron ◽  
J Reinsberg ◽  
R Fimmers ◽  
N Sänger ◽  
K van der Ven ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Prognostic Value ◽  
Primordial Follicles ◽  
The Real

Long-term effects of childhood cancer treatment on hormonal and ultrasound markers of ovarian reserve

2019 ◽  
Author(s):  
van den Berg MH ◽  
Overbeek A ◽  
Lambalk CB ◽  
Kaspers GJL ◽  
Bresters D ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Childhood Cancer ◽  
Ovarian Reserve ◽  
Long Term Effects
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