Table 1.
Comparison of orthotopic and heterotopic ovarian tissue auto-transplantation
| Attribute | Orthotopic | Heterotopic |
|---|---|---|
| Location | Frozen-thawed cortical ovarian tissue to the remaining ovary, ovarian fossa, or broad ligament | Frozen-thawed cortical ovarian tissue to the subcutaneous abdominal wall, forearm, beneath the peritoneum, and rectus muscle |
| Possibility of natural conception | Yes | No; requires IVF |
| Surgical approach | Might be complexa, invasive | Simple, less invasive |
| Advantages | -Spontaneous pregnancy is possible -No ovarian stimulation of delay in cancer treatments. Favorable environment for follicular development -Favorable environment for follicular/oocyte development |
-Easy access for follicular monitoring and oocyte retrieval -No ovarian stimulation of delay in cancer treatments. Favorable environment for follicular development -Alternative for patients with pelvic adhesions or poor vasculature -Increased surgical ease for transplantation |
| Disadvantage | -Risk of reintroducing malignant cells -Increased risk of post-grafting ischemia and follicular atresia -Spontaneous pregnancy can occur due to ovulation from remaining ovary |
-Risk of reintroducing malignant cells -Increased risk of post-grafting ischemia and follicular atresia -Requires IVF -Abnormal environment for follicle and oocyte development |
| Documented restoration of endocrine function | Yes; restoration of endocrine function 2–9 months post grafting with functioned reported for up to 7 years | Yes; restoration of endocrine function 2–9 months post grafting with functioned reported for up to 7 years |
| Documented live births | Yes; >80 live births | Yes; 2 live births |
| Delay premature ovarian insufficiency | Possible | Possible |
| Goal | To resume endocrine and reproductive ovarian functions | To resume endocrine and reproductive ovarian functions |
| Freezing/thawing | Slow freeing or vitrification | Slow freezing or vitrification |
| Transplantation | Avascular graft of frozen-thawed cortical ovarian tissue | Avascular graft of frozen-thawed cortical ovarian tissue |