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Fertility Preservation
The Future of Reproductive Organ Transplant – A Brief Review
Peter Wong,
1
Andreea Poenariu,
2
Jeanetta Stega,
1
Anjana Nair
1
and Giuseppe Del Priore
3
1. Department of Obstetrics and Gynecology; 2. Department of Internal Medicine; 3. Vice President of Research, Director of Gynecologic Oncology,
Department of Obstetrics and Gynecology, New York Downtown Hospital, New York
Abstract
Reproductive organ transplant continues to grow in terms of both interest and the number of cases year after year. Successful
pregnancies after ovarian tissue transplantation have been reported widely in the lay press, stimulating this phenomenon. Advances in
immune-suppression and immune-modulation research ensure the future of reproductive organ transplant as an increasing therapeutic
reality. Reproductive organ transplantation is important because it enables individuals who were once infertile and untreatable by other
assisted reproductive technologies (ARTs) to produce offspring. Reproductive organ transplant is an option that overcomes the technical
and ethical objections to some causes and treatments of infertility. This article outlines some of the historical context, current studies
and the future outlook in the field of reproductive organ transplant.
Keywords
Reproductive organ transplant, uterus transplant, ovarian transplant, fertility preservation
Disclosure: The authors have no conflicts of interest to declare.
Received: 10 March 2009 Accepted: 6 April 2009
Correspondence: Giuseppe Del Priore, New York Downtown Hospital, Obstetrics and Gynecology, 170 Williams Street, New York, NY 10038, US.
E:
Giuseppe.delpriore@downtownhospital.org
In 1963, Murray et al. announced the first successful pregnancy in a cavity into the scrotum. A number of individuals with unilateral or
patient who had received a renal transplant.
1
Since then, a number of bilateral cryptorchidism will suffer from altered spermatogenesis and
successful pregnancies have occurred in patients who have received an increased risk of testicular cancer.
9
The longer the testes remain
various organs from different systems: kidney, liver, pancreas, heart undescended, the higher the risk of infertility.
10
Of the acquired
and lung.
2
However, it is only in the past five years that successful testicular infertility factors, infection is one of the most significant
pregnancies after ovarian tissue transplantation have been reported.
3–5
contributing factors. Viral orchitis, especially mumps infection, has
Reproductive organ transplant has seen a resurgence of interest in the been established as a potential cause of infertility in young men. The
past few years.
6
With the rapid advances in immune-suppression and mechanism of injury that leads to infertility has been proposed to be
immune-modulation research, the future of reproductive organ related to germinal cell damage or the ischaemia caused by the
transplantation appears to be promising. The future of reproductive inflammatory changes that occur.
11,12
Other infections that may cause
organ transplant is important because it can potentially enable infertility include Neiserria gonorrhea, Chlamydia trichomatis and
individuals who were once infertile to produce offspring, whether by Mycobacterium tuberculosis.
13
assistance with reproductive endocrinology or by natural means of
conception. For some, reproductive organ transplant is the only Female
possibility that may allow them to produce offspring. Female infertility factor can be broken down into uterine-related and
ovarian-related factors. Congenital causes of uterine infertility factors
Infertility Factors include uterine agenesis such as Mayer-Rokintansky-Kuster-Hauser
Male syndrome or uterine hypoplasia. Mayer-Rokintansky-Kuster-Hauser
According to research published by a World Health Organization affects approximately one in every 5,000 live female births.
14
As for
(WHO) multicentre study, 20% of all infertility can be attributed to male the acquired causes of uterine infertility factors, a number of women
infertility factor. Female infertility factor is responsible for 38% and of childbearing age will suffer from various conditions that have a
combined infertility factor for 27%; the remaining 15% has no significant impact on their quality of life and their ability to carry out
identifiable cause.
7
Testicular infertility is one of the most common a successful pregnancy; these include uterine fibroids, intra-uterine
causes of male-organ-related infertility. Testicular infertility factor can adhesions and previous hysterectomies. Fibroid uterus can often be a
be divided into two categories: congenital and acquired. The most painful and troublesome disease, with symptoms such as
common congenital cause of testicular infertility factor is dysfunctional uterine bleeding and severe pelvic pain, but more
cryptorchidism, which is the failure of the testes to descend into the importantly it renders the uterus unable to sustain a normal
scrotum during embryological development.
8
The testes can be pregnancy to term by various mechanisms: failure to implant, failure
located anywhere along the path of descent from the abdominal to sustain the placenta or uterine contractions leading to
42 © TOUCH BRIEFINGS 2009
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