Ovarian transposition

Ovarian transposition involves surgically moving one or both ovaries away from the pelvic cavity
before starting local radiotherapy (1). This technique has limited effectiveness due to dispersion of
radiation, which could still affect transposed ovaries. Moreover, it is technically difficult to identify
the correct anatomical position of the ovaries for shielding from radiation, especially in young girls
(2).
The risk of premature ovarian insufficiency after pelvic radiation mitigated by ovarian transposition is
highly variable, ranging from 0% to 80%, for which is why it should be combined with other fertility
preservation strategies (3). According to recent guidelines by European Society of Human
Reproduction and Embriology (ESHRE), women with an already diminished ovarian reserve, at
increased risk of ovarian metastasis, and with chemotherapy planned as part of their treatment are
not suitable candidates for ovarian transposition (4).

References:

1. Hoekman EJ, Broeders EABJ, Louwe LA, Nout RA, Jansen FW, de Kroon CD. Ovarian function after ovarian
transposition and additional pelvic radiotherapy: A systematic review. Eur J Surg Oncol. 2019
Aug;45(8):1328-1340.
2. Fawcett SL, Gomez AC, Barter SJ, Ditchfield M, Set P. More harm than good? The anatomy of misguided
shielding of the ovaries. Br J Radiol 2012;85:e442e7.
3. Donnez J, Dolmans MM. Fertility preservation in women. Nat Rev Endocrinol. 2013 Dec;9(12):735-49.
4. ESHRE Guideline Group on Female Fertility Preservation, Anderson RA, Amant F, Braat D, D'Angelo A,
Chuva de Sousa Lopes SM, Demeestere I, et al. ESHRE guideline: female fertility preservation. Hum Reprod
Open. 2020 Nov 14;2020(4):hoaa052.