Ovarian tissue cryopreservation for fertility preservation in cancer patients: successful establishment and feasibility of a multidisciplinary collaboration

Abstract

Background: As advancements in cancer therapies have led to dramatic improvements in long term survival, there has been increasing interest in methods to expand fertility preservation options for cancer patients.

Methods: An experimental protocol for ovarian tissue cryopreservation was developed at the University of Pennsylvania for patients requiring gonadotoxic therapies. The protocol for adults was implemented at the Hospital of the University of Pennsylvania and for children at the Children's Hospital of Philadelphia in collaboration with the Oncofertility Consortium and the National Physicians Cooperative (NPC).

Results: A total of twenty-one patients (age range: 8-36 years) have cryopreserved ovarian tissue as part of this study. While patients had a variety of diagnoses and treatment exposures, 10/21 (48 %) patients suffered from hematologic disorders and 43 % were anticipating stem cell transplantation. No patients have requested that the tissue be used for clinical purposes.

Conclusions: Ovarian tissue cryopreservation protocols can be implemented at pediatric and adult institutions through multi-disciplinary collaboration. While more research is needed to determine the safety and efficacy of ovarian tissue cryopreservation, this procedure provides hope for preserving the ability to have biological offspring to patients facing gonadotoxic therapies for a variety of medical conditions.

Figures

Fig. 1

Ovarian biopsy surgical procedure. Panels a–d depict a laparoscopic view of a surgical biopsy of ovarian cortical tissue

Fig. 2

Histologic analysis of ovarian cortical tissue. Panel a is a 10× view of remaining follicles in the patient’s ovarian cortex post cancer treatment despite her high FSH level of 83.8 mlU/ml. A single primary follicle is depicted in Panel b at 40× and a secondary follicle depicted in Panel c was visualized at 40×