Removal, preservation and reimplantation of ovarian tissue to restore fertility after gonadotoxic treatment
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3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 6 sources, which was discussed by the committee. The evidence included 3 systematic reviews, 1 retrospective cohort study, 1 multicentre case series and 1 registry analysis. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in table 5 of the overview.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: return of endocrine function, pregnancy, live birth rate, long-term outcomes of children born using this procedure.
3.3 The professional experts and the committee considered the key safety outcomes to be: transmission of original malignancy through reimplanted ovarian tissue.
3.4 Patient commentary was sought but none was received.
Committee comments
3.5 The committee encourages formation of a registry to collect details of patient selection, including original malignancy and age (both at harvesting of ovarian tissue and at reimplantation), details of the procedure used for harvesting and reimplantation, including the amount of tissue removed and reimplanted, live birth rates and longer-term outcomes.
3.6 The committee noted that preservation of ovarian tissue for this procedure is regulated by the Human Tissue Authority (HTA). Only ovarian tissue that has been stored under HTA regulations can be reimplanted.
3.7 The committee was informed that this procedure is not currently used for people with leukaemia in the UK, but there is ongoing research in this area.
3.8 The committee was informed that this procedure is not usually used when egg harvesting is an option.
3.9 This guidance covers the use of this procedure to restore fertility and not to reduce symptoms of the menopause. NICE has produced separate guidance on removal, preservation and subsequent reimplantation of ovarian tissue to prevent symptoms from the menopause (interventional procedures guidance 738).
Tom Clutton-Brock
Chair, interventional procedures advisory committee
February 2023
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