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.

Back­ground

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.

Efficacy

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%.

Risks

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.

Costs

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.