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Female fertility preservation and maximisation: is ovary freezing the final frontier?

3rd September 2018 - Louisa Ghevaert
Female fertility preservation and maximisation: is ovary freezing the final frontier?

There is ongoing debate about the limitations of a womans biological clock and the finite nature of female fertility. However, this is not the full picture.

Medical technology is available to freeze ovarian tissue, potentially for decades, and then re-implant it effectively preserving a womans fertility and delaying or even reversing menopause. In fact, some medics believe it is possible to re-implant ovarian tissue every decade to enable a woman to conceive with her own eggs into old age. This is real food for thought, particularly when it also has the potential to reduce risks of osteoporosis, heart disease and reduce reliance on HRT treatment.

Ovarian tissue freezing and transplantation could mark a quantum shift in the future treatment and management of female fertility, its preservation and maximisation. As women are increasingly delaying motherhood into their 30s and 40s (and even 50s) why is it not more commonly understood and practised as an option to preserve and maximise fertility?

Ovary freezing, transplantation and transportation

Although ovarian tissue freezing and transplantation is possible in the UK, it is only available for medical reasons and it is not always offered. It can give women suffering from a range of medical conditions the hope of a much wanted child. This can include women with: cancer, blood disorders, autoimmune diseases like Lupus (which can require chemotherapy treatment that can harm eggs and ovaries) and those facing removal of their ovaries due to cysts and endometriosis.

In the US, ovarian tissue freezing costs between $10,000 - $20,000 plus annual storage charges of $300 - $500. However, data is limited and the overall number of procedures undertaken is still low because it is still viewed as experimental.

Denmark leads the world in ovarian tissue freezing and transplantation. It has been practised in Denmark since 1999 and undertaken by approximately 1,000 women. It is reported that 15 Danish children have been born as a result of this technique. Young women in Denmark with cancer are routinely offered this. Although further medical research is needed, medical evidence indicates there is little risk of the cancer reoccurring although some medics believe it could increase risks of womb or breast cancer.

Freezing ovarian tissue and undergoing transplantation at a later date potentially offers greater flexibility than egg freezing. It has the potential to restore natural fertility, produce more eggs and it can delay the menopause. In contrast, egg freezing produces a limited number of eggs following fertility treatment and egg harvesting.

In situations where women suffer aggressive medical conditions requiring urgent life-saving treatment which destroys their fertility (for example chemotherapy), they may be medically advised against undergoing fertility treatment to harvest their eggs. This might be because there is insufficient time to undergo the required fertility treatment protocol over several weeks. It might also be because the hormone drugs required to stimulate the ovaries before egg harvesting could exacerbate their aggressive cancerous condition. In contrast, freezing ovarian tissue can be achieved quickly and without the need to take hormone drugs. Ovarian tissue freezing is the only fertility preservation option for pre-pubescent girls who require urgent chemotherapy to treat cancer. Medical technology does not yet enable a woman to donate ovarian tissue to another woman (except for an identical twin) because both women must be an exact blood and tissue match. The recipient would also need to take immunosuppressant medication, which medics believe would compromise the ovarian function and prevent a pregnancy. Ovarian transportation can surgically re-locate ovaries away from the abdomen if radiotherapy treatment is required to treat cancer. However, this procedure does not preserve ovarian function if chemotherapy is required.

Egg freezing

There has been increased debate about egg freezing recently because medical technology enabling the successful freezing of eggs has improved in the last few years. It is now offered by many UK fertility clinics. This is in stark contrast with ovarian tissue freezing and transplantation procedures which are not widely offered in the UK.

A fertility treatment cycle resulting in egg harvesting may produce up to 15 eggs (although numbers can be less than this). The process can typically take 2- 3 weeks. The average cost of egg freezing can be £2,500 - £5,000 plus storage costs of an additional £150 - £400 per annum. An egg freezing cycle is therefore cheaper than the costs of ovarian tissue freezing and transplantation in the US (although costs can mount up if multiple egg collection procedures are undergone).

However, there remains limited data on the success rates of conception with frozen eggs. According to the latest figures from the HFEA, since 2010 there have been 471 babies born from frozen eggs in the UK. On 2 May 2017, the HFEA issued the following statement about egg freezing:

Egg freezing has become more widely available over recent years, though the numbers are still too low for us to publish clinic-by-clinic data. Our latest national data on egg freezing shows that the pregnancy rate is around 22%, but this is for women of all age groups and is likely to include eggs frozen using older techniques. We require clinics to give an accurate prediction of the chance of success from any fertility treatment and we check patient information on inspection.

As such, freezing eggs does not guarantee a baby. Eggs must successfully freeze, thaw, fertilise, implant and go on to produce a live birth. It requires a range of tests, including blood tests, medical screening and daily medication to stimulate the ovaries. The procedure for egg retrieval is usually done under light sedation. In some cases, women can suffer from ovarian hyper stimulation syndrome as well.

Preserving and maximising fertility, together with modern family building, creates increasingly complex medical, legal, practical and emotional issues that challenge and outpace the law. This makes it important not to assume that law will cover your personal situation and plans for the future. Fertility preservation and maximisation, together with modern family building requires understanding and careful management of the legal issues, implications and outcomes from the outset. Reliance on medical protocols and procedures is not sufficient on its own. Fertility patients need to be able to make informed decisions about fertility preservation, maximisation and treatment that are right for them. They must also understand, complete and sign consent forms at UK fertility clinics governing their legal status, rights and responsibilities and procurement, storage and use of their gametes and any embryos comprising these. This requires specialist fertility, parenting and modern family law advice.

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