Ovarian Transposition (Oophoropexy)
Ovarian transposition is a potentially effective option for preventing damage to the ovaries during pelvic radiation therapy. Also known as oophoropexy, this surgical procedure may be appropriate for a woman who will receive radiation treatment for cervical cancer and would like to preserve her fertility and prevent premature menopause by minimizing the exposure of her ovaries to radiation.
What does oophoropexy involve?
Because the ovaries are located in the lower pelvis, these female reproductive organs can absorb radiation during pelvic radiation therapy. The eggs in the ovaries, or oocytes, are very sensitive to radiation injury. The doses of radiation used to treat cervical cancer can easily destroy some or all of these oocytes, leading to infertility and early menopause.
The goal of ovarian transposition is to move the ovaries out of the field of radiation and into a different area of the abdomen to minimize their radiation exposure. Usually, a gynecologic oncologist must separate the ovaries from their attachment to the uterus and mobilize them out of the pelvis with care to preserve the ovarian blood supply. Sometimes the fallopian tubes are also separated from the uterus to get additional mobilization to ensure protection.
Ovarian transposition is performed by laparoscopy or at the time of laparotomy depending on the approach to treatment for a patient’s cervical cancer. A laparotomy is a traditional open procedure that is performed through a long incision in the abdomen. A laparoscopy is a minimally invasive procedure that is performed through a few small incisions with the aid of a miniature camera. In general, laparoscopic ovarian transposition is the preferred technique because it is associated with a more rapid recovery and less postoperative pain. Depending on the approach, radiation therapy can be started within two weeks after surgery.
Pregnancy after oophoropexy
We recommend that all women interested in fertility after cancer treatment meet with an infertility specialist before their treatment. They will most likely recommend oocyte or embryo preservation (egg or embryo freezing) before starting treatment to improve the chances of having biological children.
After completing radiation and possibly chemotherapy as well for cervical cancer treatment, it is important for a patient to understand that her ovaries and fallopian tubes cannot be reconnected to her uterus. Additionally, with the high doses of radiation needed to treat cervical cancer, she will not be able to carry a pregnancy due to the damage the radiation causes to her uterus and cervix.
For example, radiation can cause scarring that interferes with blood flow to the uterus. It also makes the uterus inflexible and unable to stretch to accommodate a growing fetus during pregnancy. Thus, she will likely need In Vitro Fertilization and a gestational carrier (surrogate). The goal of ovarian cancer transposition with, regard to fertility preservation is to potentially preserve ovarian function to harvest eggs in the future.
We understand that fertility preservation is important to many of our patients. Certain cancer treatments can interfere with a person’s reproductive ability, but there’s no need to choose between raising a family and receiving life-saving care.Fertility Preservation
Moffitt’s approach to cervical cancer treatment
Moffitt Cancer Center is one of only a few cancer centers in the nation that offer oophoropexy as a fertility-preservation option for cervical cancer patients. We encourage our patients of child-bearing age to consult with a fertility specialist to fully explore their options before starting cervical cancer treatment.
If you have been diagnosed with cervical cancer and would like to discuss your treatment options with a specialist in the Gynecological Oncology Program at Moffitt, contact us at 1-888-663-3488 or complete our new patient registration form online to request an appointment. We know that every day counts after a cancer diagnosis, and we will support you with compassionate care every step of the way. Referrals are not required.