Introduction
The cryopreservation of ovarian tissue holds huge potential for future fertility in women with cancer. It is the sole fertility preservation option for prepubertal girls and is increasingly utilised in young women in which oocyte freezing is not an option. As a proof of principle, the successful freezing of ovarian tissue has been established by our group in a woman with a history of bilateral oophorectomy in whom grafting of the frozen-thawed tissue resulted in a successful birth from eggs recovered from the graft. Although there has been wider acceptance of this technology and it is increasingly regarded as innovative, as opposed to experimental, there is still a lack of knowledge of its potential in re-establishing fertility after cancer treatment.
Study
The Royal Women’s Hospital, Melbourne established the first fertility preservation service in 1994 and over 750 women, adolescent and prepubertal girls have frozen ovarian tissue, 83.7% due to a cancer diagnosis and 16.3% for a benign condition requiring gonadotoxic treatment. Lymphoma was the most common malignant condition (18.5% of cases), followed by sarcoma (15.6%) and breast cancer (13.7%).
In our cohort, 5% of patients returned to use their tissue: 31 with a previous malignant condition and 9 with a benign condition. All women, except three, resumed cycling after grafting of the thawed tissue, on average 4 months following grafting. In those wishing to attempt pregnancy 7 live births were achieved in the malignant group and 1 in the benign.
Conclusion
Multiple births from grafted frozen-thawed ovarian tissue indicates successful preservation of fertility in women with a malignant condition. We propose that it is therefore important that this option is offered to young cancer patients.