One may ask, who uses this chance? Who needs this service? For whom is ovarian tissue storage a necessity, and for whom is it an insurance, and in which case may it be needed? Is ovarian tissue preservation necessary for women, who already have children and are not planning a pregnancy anymore?
Ovarian reserve and factors that reduce it
The ovaries are the organ that makes a woman a woman, producing female sex hormones – estrogens. These are estrogens, that are responsible for the body constitution of a female type, a high timbre of voice, mood and sex drive, protect the woman’s cardiovascular system from atherosclerosis, and make her vessels more elastic. In addition, these are the ovaries, in which the eggs mature, due to which the conception of a new life becomes possible.
The peculiarity of the female body is also in the fact that each girl at birth already has a number of eggs “planned” by nature. In reproductive age, they are not constantly produced by the body, like male germ cells, but mature at a certain point from the available supply. This stock is an ovarian reserve. Over the years, it has been decreasing: the older the woman becomes, the fewer eggs, ready to conceive, can mature in the ovaries, and their quality worsens: with age, not only does the probability of conceiving a baby decrease, but the chances of passing on serious diseases increase. The “reference point” from which a rapid decrease in the ovarian reserve in a healthy woman begins is approximately 30 years of age. This should be remembered by those who, for personal or social reasons (career growth, plans to move to another country, lack of a permanent partner), postpone the birth of a child to a later period: the older the woman, the more difficult it can be to conceive naturally due to exhausted ovarian reserve. There is also a syndrome of premature ovarian exhaustion, which leads to an even earlier decline in reproductive function.
It is important to remember about external factors that can negatively affect the unripe ova. We are talking primarily about chemotherapy or radiation in cancer tumors. Such therapy may be needed at any age, it is quite possible that at the time of treatment the woman does not yet have children. Under the influence of treatment, reproductive cells are likely to die or undergo changes that make it impossible to conceive a healthy baby.
Surgical operations on the reproductive organs, primarily on the ovaries, also negatively affect the ovarian reserve.
How to maintain the ability to give birth to a baby
In order to preserve the reproductive function of women, ovarian tissue cryopreservation is used. This biological material is collected during laparoscopic surgery. Which part of the organ will be taken for storage is being decided in each case individually and depends on medical indications and the reason why this procedure was needed. Next, the ovarian tissue is subjected to laboratory testing, processing and preparation for storage, then it is frozen and transferred to a cryogenic storage, where biological material is stored in special containers at a temperature of -196 °C.
Some cryobanks also offer egg storage services. The process of preparation and collection of this biological material is different, and it has certain contraindications. For example, in malignant tumors, it is often impossible to use hormonal preparations that are used before the egg puncture procedure. For the same reason, this procedure is contraindicated in some gynecological diseases. In such cases, the only solution is to preserve the ovarian tissue, which can also be used to restore hormonal function, whereas cryopreserved eggs cannot be used for this, they can only be used for the in vitro fertilization cycle.
What is done with ovarian tissue after thawing
Ovarian tissue, like other biological materials, can be stored in a cryobank for an unlimited time without loss of quality provided that the bank complies with international protocols for the preparation and storage of biological materials and guarantees compliance with all requirements for the operation of cryobanks.
Ovarian tissue is removed from the cryostorage, when the client, who stored it, has decided to become pregnant and have a baby or wants to restore the hormonal function of the ovaries and the menstrual cycle. Pregnancy planning after cancer treatment is usually possible after 3-5 years of remission, and after gynecological surgery the doctor makes the decision about the possibility of pregnancy, depending on the situation. A woman, who has preserved ovarian tissue as insurance to preserve reproductive function can use biological material when she decides it is necessary.
After thawing, the stored ovarian tissue is seated to the remaining tissue or to the ovary, if the organ has been completely preserved, and if transplantation is needed only to restore the hormonal function of the ovary, it is placed under the skin of the abdominal wall. Transplanted tissue performs the function of an organ, a woman has the opportunity to become pregnant naturally or undergo a standard course of treatment using assisted reproductive technologies. With any method of retransplantation, i.e. transplanting a tissue to the remaining organ, transplanting an organ, or replacing tissue cells under the skin of the abdominal wall, the menstrual function is restored, hormonal levels normalize, and the production of sex hormones renews, thanks to which a woman maintains her femininity, reproductive health and youth. Many clinical cases prove that the ovarian tissue after transplantation successfully survives, and its functional activity is restored: today in the world more than 100 children were born to women after transplantation of their own cryopreserved ovarian tissue.
Ovarian tissue: when is its storage recommended
- The need to treat a malignant tumor using chemotherapy or radiotherapy. It is important that tissue, collected in adolescence or before puberty can be used for freezing. One of the significant examples is the restoration of reproductive function in a woman with the help of ovarian tissue, which was frozen when she was 13 years old. The girl had a complicated treatment of sickle cell anemia with bone marrow transplant, as a result of which her reproductive function was affected. 12 years after the treatment, due to transplantation of her own ovarian tissue, she regained her menstrual function, and two years later, at 27 years of age, she gave birth to a healthy child. This case was published in 2015 and this woman became a mother in 2014. This is the first case in the history of medicine when reproductive function was restored due to transplantation of ovarian tissue taken from a patient yet in childhood.
In 2011, for the first time in Germany, a woman gave birth to a child after transplantation of her own ovarian tissue, stored in 2005, at the time of biomaterial collection, she was already in the reproductive age. In 2014, the first child was born in Estonia after retransplantation of ovarian tissue. As mentioned above, in the world today, more than 100 children were born after such a transplant, that is, retransplantation of their own ovarian tissue.
- The need for surgical treatment in gynecology. In some cases, if ovarian surgery is necessary, women are advised to store the tissue of this organ for future use.
- Pregnancy planning after 30 years of age. Since a decrease in ovarian reserve with age is a natural process, women who postpone the birth of a child to a later period are at risk of infertility. Gynecologists recommend that women who do not have children till 28-30 years of age, undergo an examination and make an “investition into insurance”, i.e. preserve ovarian tissue for the case, if till the moment of planned pregnancy eggs do not mature in ovaries.
Who is not recommended to preserve ovarian tissue
Like any medical procedure, ovarian tissue collection with its subsequent storage has some contraindications.
- The procedure and storage of ovarian tissue is not recommended for women over 41 years of age, even if that they had no children before.
- The procedure of ovarian tissue collection and storage is not performed in the case of a malignant tumor of the ovary, the tissue of which was supposed to be preserved.
- Contraindication is chemotherapy performed prior to the proposed procedure of ovarian tissue collection. This is due to the fact that such treatment with a high probability could have damaged the cells and negatively affected the function of ovaries.
In many cases, ovarian tissue storage in a cryobank is the only chance to maintain the ability to conceive and have a healthy baby even after a serious illness or after the age of 40. Assisted reproductive technologies have been developing intensively over the past decades, and the first girl born as a result of IVF is already 50 years old, and she herself became a mother, having conceived a child in a natural way. The ability to preserve ovarian tissue and restore reproductive function after transplantation is an important step in reproductology, and any woman who needs it, can benefit from it.