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| Freezing of ovarian tissue |
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Information to women who wishes to have frozen tissue from an ovary
Background
Your ovaries contain all the eggs that from puberty to postmenopausal ensure you that you are able to get pregnant, and that at an egg is released from the ovary each month in regard to ovulation. The eggs are already produced at birth and you cannot produce new eggs.
Cryopreservation of ovary tissue can be relevant at several conditions:
- Previous to chemotherapy and/or radiotherapy.
- If you are hereditary predispositioned to an early postmenopausal.
- By repeatedly formation of cysts in the ovaries that require repeatedly operations and therefore/ with a risk that egg cell genes will perish.
- At prevalent endometriosis which result in repeatedly surgery of the ovaries.
Treatments that can ravish many – or in worst case – all the eggs in the ovaries. When your ovaries are discharged for eggs you will not have ovulation, absence of menstruation and you cannot be pregnant in a normal way. It will correspond to postmenopausal at an early stage. Many of the problems which this brings can be resolved with hormone treatments, but you cannot get pregnant without eggs.
Unfortunately, it is difficult to predict in which extent your ovaries will be damaged by abovementioned conditions. Among others the damage is dependant on your age and which treatment you receive, but two women receiving the same treatment can react differently. In this way one woman can experience that she will pass through postmenopausal, while another woman has normal menstruation and can get pregnant, in spite of the fact that they both receive the same treatment. Therefore, the treatment might show that freezing of ovarian tissue has not been necessary anyway.
Since 1999, it has been possible to preserve frozen tissue from ovaries from more than 200 women in Denmark. So far, only a few have got a replacement of their unfrozen tissue. At all these women, the tissue has resumed its hormonal production and they have got their normal menstrual cycle back. For the first time in 2004, a child was born by a foreign woman who had got a replacement of unfrozen ovarian tissue, and only two healthy children have been born in total worldwide. This treatment is in an early stage and the techniques are developing constantly. Therefore, it is urgent to point out that it is a case of an experimental treatment and not a guaranteed ability for pregnancy.
Discharge
Discharge of the tissue is carried out by laparascopic surgery under full anaesthesia. One or a part of the one of your two ovaries is removed. It is very rarely that problems occur, but there are always risks at anaesthetics and operations. You can risk a bleeding and inflammation in the stomach. Besides, damages on the organs which lie nearby the genital organs; that is bladder, ureters and intestine. On seldom occations it is not possible to operate with laparascopic. A few will therefore be operated by a real operational cut at the stomach below. It is not possible to evaluate until after the operation has commenced and as you cannot be awakened during surgery and informed of this, it is important that you are aware of this risk before surgery.
Cryo-preservation
The tissue is cryo-preserved and kept at -195°C. At this low temperature it can be preserved and contain viability in years. It is only the cork cambium from the ovaries that is cryo-preserved, as it is here the main part of the eggs in the ovaries is to be found. A small piece of the discharged tissue is not frozen, but discharged for examination in a microscope as to estimate, how many eggs that lie in the ovarian.
The rest of the ovarian tissue, which are not cryo-preserved, are being destroyed.
The cryo-preserved tissue is preserved until you actually wish to have an replacement. You can at any time request to have the tissue unfrozen and destroyed. After your death the tissue will be unfrozen. The tissue is destroyed or the cells die by embedding the tissue in formaline.
Replacement of tissue
When you have a wish to recommence the ovarian function, eventually for the purpose of pregnancy, the tissue can be replaced. Upon where the ovarian tissue might be replaced is an individual judgement from one woman to another. So far, we have tried to replace the tissue in the remaining ovary, in the abdomen or in the epithelium. A replacement will again need a laparascopic surgery with the same risks as at the first operation. Besides, it is expected that you will be needing help for pregnancy – that is ”artificial insemination”.
At this time there are no rules of how old you must be, when the tissue is to be replaced.
However, we recommend that an eventual pregnancy not occur on a later stage than other women might have. Therefore, the tissue should not be replaced after the turn of 40 years.
Other possibilities (alternatives) to preserve fertility
It is possible to cryo-preserve fertilized eggs. It normally takes several weeks of hormone treatments and also the fact that the woman has a partner whom she wants to be pregnant with. According to Danish Law cryo-preserved and frozen eggs can only be stored for five years.
Non-fertilized eggs, which are removed by the technique of reaction tubes, can be frozen. The method is though very difficult and is not actually performed in Denmark. The same time limit of five years is also applying here.
It is possible to get pregnant and give birth (have children) with eggs from another woman. This is called egg donation. These donated eggs can be fertilized with your husband’s sperm and replaced again in your uterus. Only very few eggs are at disposal in Denmark, as there is certain rules to those who must donate such eggs.
The chance of pregnancy at egg donation is in the meantime very high and some couples choose to go abroad with the object of treatment.
Depending on your age and a number of other circumstances, there is furthermore an opportunity for adoption.
Certificate of consent
I am informed orally and in writing about freezing of tissue from one of my ovaries.
I am informed of the risks in connection with anaesthesia and operation, including risk of the fact that laparascopic surgery is not possible as well as risk of inflammation, bleeding and damage on adjacent organs.
I am informed that there might be circumstances that make it indefensible to replace the tissue as well as there is no guarantee that I get pregnant.
Name ____________________ Civil.-number __________________
Date ____________________
Consulting Doctor Name ____________________
Date _________________________
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