Diminished ovarian reserve and ectopic ovaries in patients with Mayer-Rokitansky-Küster-Hauser syndrome candidates for Uterus Transplantation: our experience

Abstract

Diminished ovarian reserve and ectopic ovaries in patients with Mayer-Rokitansky-Küster-Hauser syndrome candidates for Uterus Transplantation: our experience Basilio Pecorino1, *, Giuseppe Scibilia1 , Placido Borzì1 , Maria Elena Vento1 , Pierfrancesco Veroux2 , Paolo Scollo1 1Gynecology and Obstetrics Units, Maternal and Child Department, Cannizzaro Hospital, 95126 Catania, Italy 2 Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences, University Hospital of Catania, 95123 Catania, Italy *Correspondence: eliopek@gmail.com (Basilio Pecorino) DOI:10.31083/j.ceog4804143 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 31 March 2021 Revised: 16 April 2021 Accepted: 17 May 2021 Published: 15 August 2021 Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disease characterized by variable degrees of utero-vaginal agenesis. A diminished ovarian reserve and ectopic ovaries are common in these patients. The objective of this study is to highlight the issues relating to assisted reproduction in patients with MRKH syndrome who are candidates for Uterus Transplantation and to describe alternative methods to the classic transvaginal oocyte retrieval. Methods: In Italy, the Research Project for Uterus Transplantation from brain-dead donor started on 14/06/2018 (n. 1438/CNT2018). The potential recipients underwent to clinical evaluation, laboratory and instrumental tests to achieve eligibility for transplantation, ovarian stimulation and oocytes retrieval at the Obstetrics and Gynecology Unit of the Cannizzaro Hospital of Catania (Italy). A retrospective analysis of all patients affected by MRKH syndrome who are candidates for uterus transplantation was performed in order to highlight the problems encountered in assisted reproduction due to poor ovarian reserve or extra-pelvic gonads. Results: 15 of 64 patients (23%) were excluded after the first visit due to the poor ovarian reserve and/or ectopic ovaries. A 27-years old patient with MRKH syndrome type 2, with extra-pelvic ovaries and good ovarian reserve underwent ultrasound-guided and laparoscopically assisted transvaginal and transabdominal oocyte pick-up, with total retrieval of 12 oocytes and no short or long-term complications. Conclusion: Laparoscopically assisted oocyte retrieval is a feasible technique that can overcome some limitations for inclusion on waiting list for Uterus Transplantation, such as ectopic ovaries. Keywords Assisted reproduction; Laparoscopy; MRKH syndrome; Oocyte pick-up; Uterus transplantation