Treatment
Before starting on chemotherapy or radiotherapy, the patient would undergo a keyhole procedure to remove one of the ovaries. The procedure is done under general anaesthesia and lasts for about an hour. Should the patient require surgical treatment for her cancer, the two procedures may be scheduled at the same time, if feasible. After the ovarian tissue is harvested, it is prepared for storage using specialised freezing techniques known as cryopreservation.
In most cases, the transplant of the ovary back into the patient’s body can only take place at least two years after the end of the cancer treatment, when the cancer is in remission. Before the transplant, the stored ovarian tissue will be thawed and checked for any spread of cancer.
Given the limited lifespan of ovarian tissues, transplantation will be postponed until the patient is ready to conceive. If needed, the patient will be referred to an obstetric specialist to discuss potential pregnancy complications unique to cancer survivors.
The two types of transplantation are:
1) Orthotopic ovarian transplantation: Grafting of ovarian tissue back into the body with the aim of allowing natural pregnancy to occur. It is currently the most effective technique for transplantation and has resulted in a series of live births.
2) Heterotopic ovarian transplantation: Grafting of ovarian tissue to another site in the body which allows easy access to the egg cells, most commonly underneath the skin of the forearm or the abdomen. As heterotopic transplantation does not involve major abdominal surgery, this approach is beneficial for patients where repeat abdominal surgery may be complicated. However, this technique does not allow for natural pregnancy and in- vitro fertilization is needed for conception.