OVARIAN TISSUE FREEZING (CRYOPRESERVATION)
Freezing tissue from the ovaries can give children and adults undergoing treatment for cancer or other disorders that affect the ovaries a chance for future fertility and hormone production. It is also an emerging option for fertility preservation in healthy females who wish to delay childbirth for personal and professional reasons.
The ovary's egg-producing tissue is removed, frozen, and stored until the patient has finished therapy, her regular hormone production has resumed, or she desires to conceive.
Ovarian tissue freezing is sometimes called ovarian cryopreservation or ovarian tissue banking. This is different from oocyte cryopreservation, or egg freezing, where only the woman’s egg is preserved.
Below we will talk about what to anticipate, the associated risks, and how ovarian tissue freezing might protect fertility.
What Is Ovarian Tissue Freezing?
Several conditions and treatments may affect your fertility (the biological ability to have children). To address this issue, before beginning therapy, you can remove, freeze, and store your ovarian tissue using the ovarian tissue freezing process. This safeguards the ovarian tissue from harm during your treatment so you can use them in the future when trying to conceive.
Before beginning cancer treatment, one of your ovaries is removed for ovarian tissue freezing. The portion of your ovary that contains your eggs is separated from the remaining non-egg portion. Your tissue is then frozen and stored.
The tissue will be surgically reinserted into your body when you are ready to conceive. If you are no longer fertile after the treatment, using this tissue may help you get pregnant.
According to a study published in Reproductive Sciences, 37% of women who chose to have their ovarian tissue frozen successfully got pregnant.
Compared to egg freezing, the success rates of ovarian tissue freezing are lower. Yet, the treatment is superior to egg freezing because it can also delay menopause and restore natural fertility, claim the study's authors.
However, according to some studies, ovarian tissue cryopreservation has been shown to increase the risk for premature menopause due to fewer egg cells remaining in the ovaries following the procedure.
Being a recently developed method that has shown promise, the safety and efficacy of cryopreservation is an evolving subject with more clinical trials needed for definitive answers.
Why Should I Freeze My Ovarian Tissues?
As a side effect of specific medical procedures such as cancer surgery, radiation, or chemotherapy, females may experience reduced fertility or hormone production.
Ovarian tissue preservation has the additional benefit of hormone synthesis and increases the likelihood of conception. When a woman's ovaries are damaged, the production of vital hormones like progesterone or estrogen goes down, necessitating hormone therapy. After treatment, healthy ovarian tissue that was previously frozen can be reimplanted to restore natural hormone production.
Cryopreservation Of Ovarian Tissue In Healthy Females
Ovarian tissue freezing has been a potential method for preserving fertility during the past few decades. Frozen ovarian tissue may have thousands of viable oocytes instead of only a few eggs or embryos.
Even though several reproductive clinics in the USA and Europe provide ovarian tissue and oocyte freezing to healthy women concerned about losing their natural fertility, the leading professional bodies agree that this is premature, given the experimental nature of these procedures.
However, ovarian tissue freezing offers hope for future fertility and has applications beyond cancer patients. Many experts in the field anticipate that as these techniques advance, they will increasingly be employed for "non-medical reasons" as well. These reasons may include personal and professional ambitions or the simple lack of a suitable partner to begin a family.
Women who choose to delay pregnancies are given a chance to preserve their fertility through ovarian tissue freezing. Men already have the option of freezing their sperm. Although this is done for medical reasons, sperm banking is also commercially offered to protect male fertility for men who work in hazardous workplaces or participate in sports like hockey, football, or cycling.
Ovarian tissue freezing gives women reproductive autonomy and the freedom to decide whether, when, and with whom to have children. It also provides an alternative for adult women who choose to forego ovarian stimulation.
Who Is Eligible For Ovarian Tissue Cryopreservation?
Ovarian tissue freezing is not for everyone. However, you may be eligible if any of the following applies to you:
Chemotherapy or radiotherapy will result in the loss of many eggs. As a result, after treatment, you are at high risk of being infertile (unable to conceive naturally).
You may have enough eggs to remain fertile. However, this may not be the case if you are over 40 or had most of your eggs destroyed during previous cancer treatment.
Your eggs or embryos cannot always be frozen before therapy. Although freezing eggs or embryos is typically the best choice to maintain fertility, not everyone is eligible for this procedure.
You might not be able to freeze your eggs or embryos if any of the following apply to you:
- You just finished chemotherapy
- You cannot wait for the two weeks it takes to have your eggs or embryos frozen and need to start your cancer treatment immediately
- You are too young to have mature eggs (typically before you reach puberty)
What To Expect?
An ovarian tissue cryopreservation treatment can be completed as a same-day operation and lasts around one hour. It may also be combined with other operating room procedures to reduce the need for additional anesthesia. In addition, small abdominal incisions are typically involved, making it a minimally invasive procedure.
Surgery to remove one of your ovaries is the first stage in the ovarian tissue freezing procedure. Under anesthesia (while you are asleep), the surgeon makes a small abdominal incision and then inserts a laparoscope, a narrow tube. Next, the surgeon cuts the tissue from one ovary's surface, which stores immature eggs.
It is usually necessary to remove just one ovary to obtain enough tissue. The tissue is carefully cut into tiny bits and quickly frozen. Frozen ovarian tissue can be retained for several years in adequately designed storage facilities where samples are meticulously monitored and preserved.
What Happens When You Are Ready To Use The Tissue?
When your medical therapy is over and you are ready to conceive, doctors will thaw the tissue and reintroduce it to the body. This procedure is also done using laparoscopy. The tissue may be deposited into the pelvis near the remaining ovarian tissue by creating a pocket in the peritoneum, the membrane that covers the organs in the abdomen.
Ovarian activity should start or continue a few months after the thawed and restored tissue has been replaced. Pregnancy attempts can now be initiated with the advice of a fertility doctor.
Some women may become pregnant naturally, while others will require in vitro fertilization (IVF). IVF involves removing mature eggs from your body and creating embryos in a lab by fertilizing them with sperm. The embryos are then inserted into your uterus.
Medical professionals are researching how to mature eggs in the lab without reintroducing tissue into the body. This is called in vitro maturation, which might be a possibility in the future.
What Is the Success Rate of Ovarian Tissue Cryopreservation?
Facilities for ovarian tissue cryopreservation are becoming more widely accessible, but they have only been in place for around 15 years worldwide. Therefore, very little information is available on the viability of cryopreserved ovarian tissue. But so far, there have been more than 100 pregnancies worldwide involving women in their twenties and thirties who underwent this procedure.
There have been 200 births from frozen ovarian tissue. Half of the females got pregnant after IVF, while the other half conceived naturally.
According to recent studies, around four out of every ten women who used frozen ovarian tissue to conceive were successful.
Most females who used frozen ovarian tissue to become pregnant had their tissue removed after reaching puberty. So far, only one female has given birth utilizing tissue that was removed from her as a child. Most females who had tissue removed before puberty have not yet attempted to use it.
As their ovarian tissue was reinserted into their bodies, almost all females had their ovaries function again. This tissue often works for up to five years after being reinserted into your body. Estrogen production begins in the tissue, delaying the onset of menopause (when your periods stop).
What Are The Risks?
Both the surgical technique of removing the tissue and the transplantation of it carry dangers because they are done under anesthesia. In addition, when the frozen ovarian tissue is reimplanted, malignant cells can be reintroduced into the body for individuals with blood cancers like leukemia.
There are similar risks of cancer recurrence in patients with Ewing’s sarcoma, endometrial, and colorectal cancer. However, the spread of cancer cells has not been detected in breast cancer and lymphoma patients who underwent ovarian tissue cryopreservation.
How Is Ovarian Tissue Cryopreservation Different From Other Fertility Treatments?
Women who have begun menstruation have access to well-established fertility preservation techniques such as embryo and egg freezing. Young women who want to freeze their eggs must take a hormone supplement to increase their egg production. A sperm donor must be readily available for embryo preservation. However, that is not always necessary, as a male companion can be found later on, thanks to egg freezing. These eggs or embryos are taken out and preserved for later use. It can take up to 10 to 14 days to finish this process.
What Is The Cost?
The price varies depending on the ovarian tissue freezing stage. When the person wants to get pregnant, there is a fee for the tissue-harvesting technique, freezing and storage, as well as the transplantation treatment. Specific insurance policies and cancer support groups may pay all or part of the costs associated with ovarian tissue freezing. Yet, you may have to pay out of pocket to freeze and store your tissue.
How Can I Get Started?
If you want to freeze your ovarian tissue, consult your healthcare provider. They will refer you to a reproductive endocrinologist (a fertility specialist).
Your physician will first ensure that you can undergo the procedure. Next, they will walk you through the procedure and review the costs involved.
You will be given consent paperwork to sign as well. These documents state that you acknowledge the risks and agree to undergo the procedure.
The Bottom Line
Ovarian tissue freezing (cryopreservation) is a treatment that can give females a chance for future fertility and hormone production. For healthy women who want to put off having children, ovarian tissue freezing is an elective option; nevertheless, it should be noted that this technology is still in its experimental phase. The portion of the ovary which produces eggs is removed and frozen to be thawed when required later. Speak with your healthcare provider if you are considering freezing ovarian tissue for medical reasons.
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- Chung, Esther H et al. “Oocyte cryopreservation versus ovarian tissue cryopreservation for adult female oncofertility patients: a cost-effectiveness study.” Journal of assisted reproduction and genetics vol. 38,9 (2021): 2435-2443. doi:10.1007/s10815-021-02222-0
- Pacheco, Fernanda, and Kutluk Oktay. “Current Success and Efficiency of Autologous Ovarian Transplantation: A Meta-Analysis.” Reproductive sciences (Thousand Oaks, Calif.) vol. 24,8 (2017): 1111-1120. doi:10.1177/1933719117702251
- Gullo G, Etrusco A, Cucinella G, Basile G, Fabio M, Perino A, De Tommasi O, Buzzaccarini G, Morreale C, Marchi L, Laganà AS, Chiantera V, Zaami S. Ovarian tissue cryopreservation and transplantation in menopause: new perspective of therapy in postmenopausal women and the importance of ethical and legal frameworks. Eur Rev Med Pharmacol Sci. 2022 Dec;26(24):9107-9116. doi: 10.26355/eurrev_202212_30660. PMID: 36591823.
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