Interventional procedure overview of removal, preservation and reimplantation of ovarian tissue to restore fertility after gonadotoxic treatment

What the procedure involves

Before starting gonadotoxic treatments, ovarian tissue is removed surgically through laparoscopy, mini-laparotomy, or laparotomy. Usually, at least half of one ovary is removed and the other ovary is left in place to act as a site for future orthotopic autotransplantation. After histological examination of a portion to exclude malignancy, most of the excised ovarian tissue is frozen for future autotransplantation.

When indicated, the frozen cortical ovarian tissue is thawed and transplanted back to the same person. It can be placed into pelvic sites such as the remaining ovary, ovarian fossa, or broad ligament (orthotopic autotransplantation) through laparoscopy or mini-laparotomy. Alternatively, it can be placed into extrapelvic sites such as the subcutaneous space of the abdominal wall or forearm (heterotopic autotransplantation). In this case, the follicle and oocyte develop outside the usual environment, so subsequent ovarian stimulation, egg collection, and in vitro fertilisation are needed to achieve pregnancy. Another technique involves the vascular grafting and anastomosis of a frozen-thawed whole ovary through mini-laparotomy or laparotomy.

Future pregnancies may require assisted reproduction technologies, although the procedure can offer the possibility of natural conception.

Ovarian stimulation is not needed before removal of ovarian tissue for autotransplantation and gonadotoxic treatment can start immediately afterwards. It may be the only fertility preservation option suitable before puberty or for people with oestrogen-sensitive malignancies.