Ovarian tissue freezing: for whom
Ovarian tissue freezing is a method of fertility preservation that, until recently, was considered experimental. Today it is established as a recognized clinical option for specific groups of women and girls.
Its particular advantage is that it needs no ovarian stimulation and no delay — features that make it valuable precisely when the other methods are not feasible.
What exactly does the method involve?
In a small laparoscopic operation, part of the outer layer of the ovary (the cortex) is removed, where thousands of immature follicles lie. This tissue is cut into thin strips and frozen.
Later, when the woman wishes to become pregnant and has completed her treatment, the tissue can be thawed and surgically re-implanted — usually in the same pelvic area. The re-implanted tissue can begin to function again within a few months.
Is it still considered experimental?
This change was based on accumulated experience and on the results: worldwide, more than 200 live births have now been reported after re-implantation of frozen ovarian tissue.
For which women and girls is it indicated?
The method is aimed mainly at two groups. First, prepubertal girls who are about to receive gonadotoxic treatment: because they do not yet ovulate, egg freezing is not feasible, so ovarian tissue freezing is the only option.
Second, women who must begin treatment urgently and for whom there is no time for the two to three weeks required by ovarian stimulation. Because the tissue is removed immediately, cancer treatment is not delayed.
What are the benefits beyond fertility?
An important advantage of the method is that, after re-implantation, the ovarian tissue restores not only the ability to conceive but also the hormonal (endocrine) function of the ovary.
This means that normal hormone production and the menstrual cycle can return, in several cases reversing the premature ovarian insufficiency caused by the treatment — with benefits for bone, cardiovascular and general health.
What are the limitations and risks?
The method requires two small operations (removal and re-implantation), with the usual risks of any surgery. The function of the re-implanted tissue is also limited in time, as it depends on the reserve of follicles it contains.
There is also a theoretical risk, especially in certain blood cancers (leukaemias), of reintroducing cancer cells together with the tissue. For this reason the suitability of the method is assessed carefully, according to the type of cancer.
When is it chosen over egg freezing?
When there is enough time and the woman is an adult with a normal cycle, egg or embryo freezing usually remains the first choice, with the most established yield in pregnancies.
Ovarian tissue freezing is chosen when the other methods are not possible — in prepubertal girls or when treatment cannot be delayed — or, in selected cases, as a complementary method. The decision is always individualized.
Summary
Ovarian tissue freezing is no longer considered experimental (ASRM, 2019) and has led to more than 200 live births worldwide. Its main advantage is that it needs no ovarian stimulation and no delay, which is why it is the only option for prepubertal girls and for women who must start treatment immediately. In addition, after re-implantation it also restores the ovary’s hormonal function. It requires two small operations and is assessed carefully in certain cancers. Egg freezing remains the first choice when there is time.
Sources: ASRM Practice Committee, “Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy” (Committee opinion, 2019, ovarian tissue cryopreservation no longer experimental); ESHRE, “Female fertility preservation” (guideline).
⚕ Medically reviewed by Prof. Stratis Kolibianakis · Thessaloniki Medical Association Reg. No. 16340
ARTICLE 29 · FERTILITY PRESERVATION
