Ovarian Tissue Freezing Preserving Future Fertility

Now Offered at University Hospitals

Innovations in Obstetrics & Gynecology | Winter 2023

Until recently, girls undergoing certain cancer treatments were left without options for starting a biological family in adulthood. Side effects from cancer therapies often damage the ovaries, resulting in infertility and premature menopause. However, ovarian tissue freezing is an innovative procedure that may provide a much-needed solution for these patients. University Hospitals is one of a limited number of hospitals that offers this service.

Rebecca Flyckt, MD

“For women with cancer, the standard modality is to freeze eggs or embryos,” says Rebecca Flyckt, MD, Division Chief, Reproductive Endocrinology and Infertility and Medical Director, University Hospitals Fertility Center. “However, girls who have not gone through puberty have very few options. We can’t stimulate the ovaries of young girls to retrieve eggs. For a long time, that limitation meant we didn’t have the means to safeguard their future fertility. But now, as survival rates for childhood cancers are so high, it’s even more important that fertility procedures like ovarian tissue freezing are available to them.”

Dr. Flyckt says ovarian tissue freezing has become a standard of care in these situations. Before cancer treatment begins, ovarian cortical tissue is harvested laparoscopically. Then, the ovary is prepared in thin strips of tissue, which can be frozen and preserved. When the patient wishes to become pregnant, sometimes many years later, the tissue is thawed and reimplanted into the abdomen.

“The ovarian tissue will attach after implantation, develop a healthy blood supply, and, thanks to robust innate hormonal signaling still in place, will begin to respond by producing eggs,” she says.

Approximately 130 live births worldwide have resulted from reimplanted ovarian tissue; about half have been natural conceptions and the others used fertility treatments such as IVF to conceive. Dr. Flyckt and her colleague, Sung Tae Kim, PhD, HCLD, Director of the IVF Lab, recently performed the first ovarian tissue freezing procedure at UH.

An Option for Some Women, As well

Although primary candidates for ovarian tissue freezing are prepubertal girls, there are times when an adult woman may choose this route, says Dr. Flyckt. For example, a cancer diagnosis that requires urgent treatment may not allow time for the patient to undergo ovarian stimulation and egg retrieval or embryo freezing, and increased hormonal levels are not advisable with certain types of tumors.

“Patients may not need their tissue for decades after freezing, so in addition to our current clinical work, we need long-term, high-quality research around birth success rates,” says Dr. Flyckt.  “We also need additional clinical research to further understand the best surgical approaches, the best methods for freezing, and the best location for implanting the ovarian tissue.”

Future Directions

Dr. Flyckt says one future possibility of ovarian tissue freezing is directly maturing eggs in the lab from the frozen tissue so that they can be fertilized in the lab to create embryos for transfer into the uterus. This eliminates the need for a second surgery.

“Ovaries are our source of estrogen, and premature menopause is a common consequence of cancer therapy,” she says. “In the future, we may want to explore the option of giving women back their natural estrogen after cancer treatment by reimplanting their own frozen ovarian tissue. This process may also help healthy women going through natural menopause. The bottom line is that there are many additional possible applications of ovarian tissue freezing that extend beyond cancer treatment.”

Multidisciplinary Care

Ovarian tissue freezing represents a true partnership in medicine at UH, blending expertise from clinical and laboratory professionals.

“Dr. Kathryn Coyne, Dr. Kim and I from the Reproductive Endocrinology & Fertility Division developed the protocol together as a collaborative effort,” says Dr. Flyckt. “But from a systems perspective, this is not just a celebratory moment for OB/GYN. Our team included pediatric hematology-oncology, the team at UH Rainbow Babies & Children’s, pediatric surgeons, our oncofertility navigator and an anesthesiologist to coordinate removing the ovary with other procedures patients need around their treatment.”

She adds: “This is a real game changer for girls and teenagers facing cancer. It’s also incredibly reassuring for patients and their families to have this option. Not all hospitals have ovarian tissue freezing programs. I feel we are perfectly situated at UH, thanks to the innovative spirit of our OB/GYN department and the strong reputations of UH Seidman Cancer Center and UH Rainbow Babies & Children’s for state-of-the-art cancer treatment.”

For more information, or to refer a patient, call 216-285-5028.

Contributing Expert:
Rebecca Flyckt, MD
Division Chief, Reproductive Endocrinology and Infertility and 
University Hospitals Cleveland Medical Center
Medical director, University Hospitals Fertility Center
Associate Professor
Case Western Reserve University School of Medicine