Cryopreservation of ovarian tissue for fertility preservation
What is it?
Currently, the main indication for cryopreservation of ovarian tissue is a diagnosis of tumor pathology requiring treatment that may result in impaired fertility (surgery, chemotherapy or radiotherapy). The increasing number of early-stage cancer diagnoses and improved prognosis has led to an increase in the number of cancer patients eligible for fertility preservation techniques.
When is this procedure indicated?
Every day in Italy at least 30 new cases of cancer are diagnosed in the population under 40 years of age. The most frequent types of cancer in this subgroup of patients are breast cancer, thyroid cancer, melanoma, colorectal cancer and cervical cancer in the young-adult age group, lymphoma and sarcoma in the pediatric-adolescent age group. These patients can access cryopreservation of ovarian tissue. Patients with benign conditions such as recurrent ovarian cysts, ovarian torsion, endocrine or autoimmune diseases may also be candidates for this type of procedure.
Endometriosis is a chronic relapsing disease that may require multiple surgeries over the course of a lifetime. Patients undergoing surgical treatment for single or bilateral endometriotic cysts are informed of the potential risk of experiencing Premature Ovarian Failure (estimated to be in the range of 2% in women with disease of both ovaries). In addition, this to these technique can be to patients in order to preserve fertility and endocrine function.
How is it performed?
Cryopreservation of ovarian tissue offers the advantage of not requiring hormonal stimulation, nor the presence of a partner.
The surgical technique consists in the collection of a fragment of ovarian cortical, about 1 cm, during the laparoscopic surgery and its subsequent freezing and preservation over time in our tissue biobank. No limits on shelf life have been described.
At the request of the woman, the fragments are thawed and then transplanted, through laparoscopic surgery, in their place of origin (orthotopic transplantation) at the level of the ovarian fold or residual ovary, allowing the recovery of ovarian function and in some cases, the possibility of spontaneous conception or more frequently after ovarian stimulation, thus resorting to techniques of Assisted Fertilization. The first baby born from autotransplantation of frozen ovarian tissue was reported in 2004 by the group of Prof. Donnez in Brussels and currently there are 130 babies born from cryopreserved ovarian tissue. If the transplant is performed in sites other than the ovary (uterus, kidney, abdominal wall, subcutis of the forearm) we speak of heterotopic transplantation and this procedure is more aimed at hormone production.
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