Laparoscopic Ovarian Transposition and Ovariopexy for Fertility Preservation in Patients Treated with Pelvic Radiotherapy with or without Chemotherapy

Background: Preservation of fertility in cancer patients of reproductive age is a concern for both the patient and the clinician. In this study, we aimed to study the effectiveness of laparoscopic ovarian transposition or ovariopexy in preserving ovarian function in women undergoing pelvic radiotherapy with or without chemotherapy for pelvic tumours. Methods: The records of patients who underwent laparoscopic ovarian transposition or ovariopexy prior to pelvic radiation therapy between 2002 and 2018 were reviewed retrospectively. Results: Thirty-nine women or adolescent girls with a diagnosis of cervical cancer (n=15), Hodgkin's lymphoma (n=6) or other types of pelvic tumours (n=18) were included in the study. The majority of patients had bilateral (n=25) or unilateral (n=8) ovarian transposition prior to radiotherapy. Nine out of 10 (90%) patients with soft tissue tumors, Ewing sarcoma or ependymoma, five out of seven (71.4%) patients with Hodgkin's lymphoma, two patients (100%) with rectal and anal cancer, and six out of 15 (40%) with cervical cancer retained ovarian function. Patients with cervical cancer, those who received concomitant chemotherapy and those older than 30 years were more likely to experience ovarian failure. Five patients conceived spontaneously and two women had four live births. Conclusion: Laparoscopic repositioning of the ovaries out of the radiation field in order to protect ovarian function in patients receiving radiotherapy appears to be effective in the majority of patients. The procedure seems safe and should be considered either as a sole procedure or in association with other fertility preservation methods prior to pelvic radiotherapy

SELECTED ORAL COMMUNICATION SESSION SESSION 06: ENDOMETRIOSIS AND SURGERY Monday 4 July 2011 10:00 - 11:30

Introduction: Tubal dysfunction is a leading factor in female infertility. Laparoscopy dye is the gold standard to detect tubal patency (laparoscopic chromohydrotubation, LSC-CHT), but hysterosalpingography (HSG) and hystero-contrast-sonography (HyCoSy) are also widely applied. Using office hysteroscopy guided selective chromopertubation (OHSC-SPT) we aimed to develop a less invasive effective and reproducible method, which can be performed in an outpatient setting without anesthesia.Material and Methods: 23 infertile patients (mean age: 32,77 ? 3,42) were examined before planned laparoscopy. A 2.7 mm optic was used, with a 5.5 mm sheath (EMD Endoscopy Technologies). A 1.7 mm diameter flexible plastic catheter (Cavafix, B-Braun) was introduced through an inbuilt channel of the sheath. Normal saline was used for the distension. The hysteroscope was introduced without grasping or dilatation of the cervix. A diagnostic hysteroscopy is performed first, then the catheter is inserted through the working channel and the tip of it is placed into the tubal orifice, through which methylene blue dye is injected slowly. In the absence of tubal occlusion the blue dye does not appear in the uterine cavity and normal color of the endometrium is seen. With damaged tubal patency the distension media of the uterine cavity turns blue, according to the backflow of the methylene blue. Laparoscopic standard tubal CHT was then performed by an operator uninformed about the OHSC-SPT results and the result were then compared.Results: Both tubes of the 23 patient were examined (N = 46). In 43 cases (93.5%) either there was an agreement with the laparoscopic findings or (5 cases, 11.6%) in spite of presence of the dye in the abdominal cavity, patency couldn't be proved properly at the time of laparoscopy. Three tubes (3 out of 41, 7,3%) were found patent with laparoscopy and were found occluded according to the OHSC-SPT. All of these false positive cases occurred at the beginning of the learning curve.Conclusion: The novel method of OHSC-SPT is an effective, highly minimal invasive method to investigate the tubal patency, which can be performed in an office setting without anesthesia. The OHSC-SPT negative/LSC-CHT positive cases suggest especially high sensitivity for tubal patency, but this finding requires further confirmatio