Detailed inform­a­tion and a list of ref­er­ences can be found in Chapter 3.3 of the FertiPROTEKT book, “Indic­a­tions and fertility pre­ser­va­tion methods for onco­lo­gic­al and non-onco­lo­gic­al disorders”, which can be down­loaded free of charge.


Ovarian tissue can be removed prior to chemo­ther­apy or radio­ther­apy, cryo­p­reserved (frozen) and retrans­planted later to restore fertility if there is a loss ovarian function.

Since the amount of cryo­p­reserved tissue is not large, the grafts are often only currently active for a few years. The trans­plant therefore does not serve to restore long-term ovarian function, which would replace hormone replace­ment therapy if it was necessary, but only the temporary resump­tion of fol­licu­lar devel­op­ment to achieve a pregnancy.

In general, the higher the ovarian reserve (i.e. the ovarian follicle density) in frozen and trans­planted ovarian tissue, the higher the chances of pregnancy.  Cryo­p­reser­va­tion of ovarian tissue is therefore ideal for younger women or even children. FertiPROTEKT recom­mends 35 as the upper age limit, although this limit may also be ca. 38 years in indi­vidu­al cases, depending on the ovarian reserve.


There is still limited data available to assess efficacy.  According to the world’s two largest case series from Denmark and the FertiPROTEKT network, with trans­plant­a­tions in over 100 women by 2015, the birth rate was approx­im­ately 25–30%.


The removal and trans­plant­a­tion of ovarian tissue requires a lap­aro­scopy under general anaes­thesia. The surgical risk is very low.

There is a risk that tumour cells are present in the ovary which are cryo­p­reserved and later retrans­planted. The risk has been estimated for various diseases. Chapter 3.3 of the FertiPROTEKT book contains detailed inform­a­tion about this risk. A small sample of the tissue is examined his­to­lo­gic­ally when the tissue is initially removed.


The costs of removal and trans­plant­a­tion of ovarian tissue vary according to hospital and surgical technique and can be broken down as follows:

  • Ovarian tissue removal (as a day-case procedure): ca. 1000 — 1500 Euros
  • Cryo­p­reser­va­tion (freezing and storage for 1 year): ca. 400 — 800 Euros
  • Trans­plant­a­tion of ovarian tissue: ca. 1000 – several thousand Euros.

The costs for the removal of ovarian tissue and trans­plant­a­tion are covered by the health insurance in some cases. The storage of the tissue must always be paid for by the patient.

Removal of ovarian tissue is performed lap­aro­scop­ic­ally under general anaes­thesia, which takes about ½ hour. About half an ovary is removed (Figure), therefore fertility is not affected by the surgery. A small sample of the tissue is examined his­to­lo­gic­ally to largely exclude tumour cells.

The tissue is frozen in the removal centre itself or is trans­por­ted to one of the FertiPROTEKT central cryobanks Bonn, Erlangen, Bern or Innsbruck, where it is processed and frozen.

Trans­plant­a­tion at a later date is performed lap­aro­scop­ic­ally. The tissue is trans­planted into the pelvic wall and/or the ovary (see Figure). At least 3 months usually pass until the tissue forms follicles. Pregnancy can occur then either naturally or by arti­fi­cial insemination.