Researchers in the US recently investigated the surgical techniques and outcomes of removing a single ovary in girls for fertility preservation.
Many survivors of childhood cancer or children with chronic medical problems experience infertility due to medical therapies. Such patients can be good candidates for fertility preservation to improve their quality of life. Non-experimental methods like embryo and oocyte preservation have limitations in pediatric patients in prepuberty and post-puberty.
Ovarian tissue cryopreservation
As of now, ovarian tissue cryopreservation (OTC) is the only pretreatment method for fertility preservation for children in prepuberty who require medical treatment that is toxic to the reproductive system. As compared to embryo/oocyte preservation, OTC does not require stimulation of hormones before tissue removal and thus can be performed without any significant delay in medical treatment.
To preserve the fertility potential of pediatric patients, OTC involves freezing the removed ovarian tissue, which is known as cryopreservation. When the patients mature into adulthood and are ready to have a child, the preserved tissue is implanted onto the remaining ovary, where it starts functioning normally and allows natural pregnancy. These techniques are considered to be experimental.
More than 130 live births have occurred after OTC
To date, more than 130 live births have been reported in adult women who have undergone OTC. In Europe, two live births have been reported in women where the ovarian tissue was preserved in prepuberty. Researchers from the United States recently conducted a review on surgical techniques and outcomes of single ovary removal for fertility preservation in pediatric girls. The findings of the study were published in the Journal of Pediatric Surgery.
Reviewing the outcomes of OTC in pediatric girls
The study review investigated a total of 64 girls, with an average age of 12 years, and the youngest age of only five months at the time of surgery from January 2011 to December 2017. Children were eligible for OTC if they were at more than 80% risk of premature ovarian insufficiency or infertility due to a medical treatment that would be toxic to the reproductive system. Half of the patients selected did not have their first periods. The single ovary was removed by laparoscopic methods in 84% of patients. OTC was performed in conjunction with an additional procedure in 76% of patients. Most of the patients (96%) were discharged within 24 hours.
Procedure did not cause any complications
The results of the study showed that this fertility preservation procedure caused no complications, and was performed safely in combination with other medical procedures, on an outpatient basis without any significant delay in treatment for cancer or other treatments that pose threat or high risk of infertility.
Thus, the study concludes that the removal of single ovaries by laparoscopy for fertility preservation is a safe technique for cryopreservation and can be performed in children of all ages. OTC can be performed in conjunction with other necessary medical procedures to minimize the exposure of the patient to general anesthesia.
As pediatric patients and their families are increasingly opting for fertility preservation, there is a need of continued monitoring of surgical, fertility and hormone outcomes in children for safer surgery with maximized quality and quantity of ovarian tissue for re-implantation and restoration of fertility in future.
Written by Pratibha Duggal
- Rowell EE, et al, Laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation in children, J Pediatr Surg(2018), https://doi.org/10.1016/j.jpedsurg.2018.06.005.
- Removal of the ovary for fertility preservation found safe in girls as young as 5 months. https://www.eurekalert.org/pub_releases/2018-10/arh-roo100118.php.