Ovarian tissue cryopreservation is
cryopreservation
Cryo-preservation or cryo-conservation is a process where Organism, organisms, organelles, cell (biology), cells, Biological tissue, tissues, extracellular matrix, Organ (anatomy), organs, or any other biological constructs susceptible to damage ...
of tissue of the
ovary
The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. ...
of a female.
Indications
Cryopreservation of ovarian tissue is of interest to women who want
fertility preservation Fertility preservation is the effort to help cancer patients retain their fertility, or ability to procreate. Research into how cancer, ageing and other health conditions effect reproductive health and preservation options are growing. Specifically ...
beyond the natural limit, or whose reproductive potential is threatened by cancer therapy, for example in hematologic malignancies or breast cancer.
[ It can be performed on prepubertal girls at risk for ]premature ovarian failure
Primary ovarian insufficiency (POI) (also called premature ovarian insufficiency, premature menopause, and premature ovarian failure) is the partial or total loss of reproductive and hormonal function of the ovaries before age 40 because of fol ...
, and this procedure is as feasible and safe as comparable operative procedures in children.
Procedure
The procedure is to take a part of the ovary and carry out slow freezing before storing it in liquid nitrogen whilst therapy is undertaken. Tissue can then be thawed and implanted near the fallopian, either orthotopic (on the natural location) or heterotopic (on the abdominal wall),[ where it starts to produce new eggs, allowing normal conception to take place. A study of 60 procedures concluded that ovarian tissue harvesting appears to be safe.] A study has also concluded that culturing a thawed fetal ovarian tissue for a few days before transplanting can be beneficial to the development of follicles.
Strips of cortical ovarian tissue can also be cryopreserved, but it must be re-implanted into the body to allow the encapsulated immature follicles to complete their maturation. In vitro maturation
In vitro maturation (IVM) is the technique of letting the contents of ovarian follicles and the oocytes inside mature ''in vitro''. It can be offered to women with infertility problems, combined with In Vitro Fertilization (IVF), offering women pre ...
has been performed experimentally, but the technique is not yet clinically available.[
]
Further comments in BBC News
BBC News is an operational business division of the British Broadcasting Corporation (BBC) responsible for the gathering and broadcasting of news and current affairs in the UK and around the world. The department is the world's largest broadca ...
article: With this technique, cryopreserved ovarian tissue could possibly be used to make oocytes that can directly undergo in vitro fertilization
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
.
Potential for Pregnancy
Women with malignant diseases that undergo treatment utilizing irradiation or gonadotoxic drugs, have an increase probability of losing ovarian function resulting in infertility. The ovarian cortical tissue harbors majority of the ovarian pool of follicles. Once a patient is cured from their malignant disease, the tissue can be thawed and then transplanted for the possibility of restoring ovarian function. Following auto-transplantation, patients showed resumption of ovarian activity to include the first menstruation at 14 to 25 weeks, and follicular development 8 to 21 weeks.
Risk of cancer recurrence
For autotransplantation of cryopreserved ovarian tissue in cancer survivors, metastases have been repeatedly detected in ovarian tissue obtained from patients with leukemia
Leukemia ( also spelled leukaemia and pronounced ) is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or ' ...
, as well as in one patient with Ewing sarcoma
Ewing sarcoma is a type of cancer that forms in bone or soft tissue. Symptoms may include swelling and pain at the site of the tumor, fever, and a bone fracture. The most common areas where it begins are the legs, pelvis, and chest wall. In about ...
.[ Ovarian tissue autotransplantation may pose a risk of cancer recurrence in patients with ]colorectal
The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before being ...
, gastric
The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
and endometrial cancer
Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb). It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most o ...
.[ However, no metastases have been detected in ovarian tissue from ]lymphoma
Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlar ...
and breast cancer
Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...
patients who have been undergoing ovarian tissue cryopreseration.
History
The first transplant of cryopreserved ovarian tissue was performed in New York by Kutluk Oktay in 1999, but it did not restore menstrual cycles to the patient. In 2004 Jacques Donnez in Belgium reported the first successful birth from frozen tissue using a protocol developed in Roger Gosden
Roger Gordon Gosden (born 23 September 1948) is a British-American physiologist in the field of female reproductive medicine. His scientific research focused on understanding the basic biology of development and senescence of ovaries in women, i ...
’s laboratory, where Oktay had studied.
In 1997 samples of ovarian cortex were taken from a woman with Hodgkin's lymphoma and cryopreserved by slow freezing (Planer, UK) for banking in liquid nitrogen. The patient had premature ovarian failure after chemotherapy. In 2003, after freeze-thawing, orthotopic autotransplantation of ovarian cortical tissue was done by laparoscopy and five months after reimplantation regular ovulatory cycles were reinitiated. Eleven months after re-implantation a viable intrauterine pregnancy was confirmed, which resulted in the delivery of a healthy baby. Donnez’s claims have been challenged because there was no absolute proof if the mother was infertile before treatment. However, Sherman Silber
Sherman J. Silber is physician specializing in the field of infertility. He invented many of the infertility treatments in use today in the domain of IVF, sperm retrieval, ICSI, vasectomy reversal, tubal ligation reversal, egg and embryo fre ...
in St. Louis, Missouri, and another of Gosden’s collaborators, Dror Meirow at the Sheba Medical Center in Israel, and subsequently others have proven beyond doubt the technique is effective. Healthy babies of both genders have been born.
The first birth following transplantation of ovarian tissue stored at a central cryo bank and transported overnight has been achieved by centers of the Fertiprotekt
The Fertiprotekt network is a cooperation of university centres, hospitals and practices. It was founded in Germany in 2006.Michael von Wolff, Markus Montag: ''6 Jahre FertiPROTEKT – Eine Zwischenbilanz.'' Gynäkologische Endokrinologie. 2 (2012 ...
network in Germany 2011. This demonstrated that ovarian tissue can be stored centrally in specialized centers.[Andreas Müller, Katja Keller, Jennifer Wacker, Ralf Dittrich, Gudrun Keck, Markus Montag, Hans van der Ven, David Wachter, Matthias W. Beckmann, Wolfgang Distler: ''Retransplantation of Cryopreserved Ovarian Tissue: the First Live Birth in Germany.'' Dtsch Ärztebl Int 109 (2012), S. 8-13, .]
References
{{Assisted reproductive technology
Cryogenics
Obstetrical procedures
Cryopreservation