Concept Paper on the Technique of Cryopreservation, Removal and Transplantation of Ovarian Tissue for Fertility Preservation

Abstract

The cryopreservation of ovarian tissue with subsequent transplantation of the tissue represents an established method of fertility protection for female patients who have to undergo gonadotoxic therapy. The procedure can be performed at any point in the cycle and thus generally does not lead to any delay in oncological therapy. With the aid of this procedure, more than 130 births to date worldwide have been able to be recorded. The birth rate is currently approximately 30% and it can be assumed that this will increase through the further optimisation of the cryopreservation and surgical technique. The concept paper presented here is intended to provide guidance for managing cryopreservation and transplantation of ovarian tissue to German-speaking reproductive medicine centres.

Successful conception in a 34-year-old lupus patient following spontaneous pregnancy after autotransplantation of cryopreserved ovarian tissue

“…The restoration rate of the endocrine function of the ovarian transplants is 85–90%, the clinical pregnancy rate is 45% and the birth rate is currently around 35–40%, although a further increase can be assumed through continued optimization of cryopreservation/thawing and surgical techniques. 8,9 Common concerns include surgical and anaesthetic risks involved in obtaining the tissue, whereas the reintroduction of malignant cells, as discussed in the literature, 14 is no concern in non-malignant diseases. The risk of premature menopause due to removal of one-half to two-thirds of an ovary can be considered as relatively small (∼1 year earlier after a unilateral oophorectomy).…”

Ovarian tissue transportation: a systematic review

“…Most studies in humans were not part our systematic review because they report outcomes of ovarian tissue cryopreservation and transplantation in clinical settings. In this context, the FertiPROTEKT network validated Custodiol® as a transportation medium for up to 22 hours, even though there are no data on its efficacy for ovarian tissue (Beckmann et al 2019. In Denmark, 12 women underwent 18 transplantations and three babies were born of two women whose ovarian fragments were transported in alpha-MEM for 4-5 hours prior to cryopreservation (Rosendahl et al 2011).…”

“…One of the most recent ART strategies, ovarian tissue cryopreservation and transplantation, is now considered an established procedure in a growing number of countries, yielding more than 130 live births to date Dolmans 2017, Liebenthron et al 2019). While this procedure is being increasingly applied all over the world (von Wolff et al 2015, Beckmann et al 2019, it is important to stress that there are still many challenges. Tissue cryopreservation requires specialized equipment, trained staff, as well as designated time and space to prepare and freeze the ovarian cortex.…”

“…Indeed, there are still no standard procedures for ovarian tissue transportation (Duncan et al 2016, Beckmann et al 2019, even though its impact can be considerable.…”

Motherhood after cancer: fertility and utilisation of fertility-preservation methods

“…As this novel option for fertility preservation was elaborately discussed and presented in the regional media, cryopreservation of ovarian tissue was the preferred fertility preservation method to be chosen in the counselling process at the University Fertility Centre in Dresden at the time of the study. Current data after autotransplantation of ovarian tissue show that the ovaries resume function in about 80-85% of women and that pregnancies can be achieved spontaneously [7]. The cryopreservations and autotransplantations were performed in cooperation with the University Hospital of Erlangen.…”