ovarian tissue were 33% for women who were under 35 years of age
at the time of cryopreservation, women who were over 35 years of
age at the time of cryopreservation showed a clinical pregnancy rate
of only 18%. Women who were over 40 years of age at the time of
tissue harvesting never became pregnant after transplantation.
After updating the overall data on ovarian tissue transplantations in the German FertiPROTEKT network, the success rates
with regard to the restoration of the endogenous function are up
to 93%, the clinical pregnancy rates are around 47%, and the live
birth rate approximates 35–43% [1, 3, 11].
Meanwhile the benefit of cryopreservation of ovarian tissue has
been shown for prepubertal girls, too [3, 17, 18], even after considering the risks associated with gonadotoxic therapy and surgery.
Ovarian tissue that was initially derived from prepubertal ovaries
resulted in more than ten live births worldwide following later
transplantation at adolescence. Further, there are published reports
that prepubertal tissue can successfully induce puberty if transplanted to girls with persisting primary amenorrhea [17, 19–
21]. The importance of fertility preservation for this young patient
group is discussed in detail by Tuppi et al. [22]. Even though the
prepubertal ovaries show no regular follicle activity, they are considerably affected by DNA damage from gonadotoxic substances,
which sooner or later will result in atresia [22]. The fact that
children have a much higher ovarian cortex potential than adolescent or adult patients of reproductive age usually gives a wrong
perception of the extent of the damage that will be caused by
gonadotoxic therapies. These female children largely enter puberty
after gonadotoxic therapy. However, if the number of the remaining, non-damaged follicles is ultimately sufficient up to the time of
the fertile phase to conceive and to achieve a pregnancy, must be
critically questioned and is often disproved in practice.
2 Materials
2.1 Medium
for Transportation,
Preparation,
and Cryopreservation
of Ovarian Tissue
All materials need to be sterile and handled under sterile conditions.
1. Custodiol, 500 mL (Dr. Franz Ko ¨hler Chemie, Bensheim,
Germany). Medium is ready to use for transportation and
preparation. It should be stored at 4
C.
2. Multipurpose Handling Medium-Complete (MHM-C),
500 mL (FUJIFILM Irvine Scientific, Santa Ana, CA, United
States), store at 4
C.
3. CryoSure-DMSO (i.e., >99.9% USP Grade DMSO), 50 mL
(WAK-Chemie Medical GmbH, Steinbach/Ts., Germany),
store at 4
C, as medium for cryopreservation.
486
Jana Liebenthron and Markus Montag
at the time of cryopreservation, women who were over 35 years of
age at the time of cryopreservation showed a clinical pregnancy rate
of only 18%. Women who were over 40 years of age at the time of
tissue harvesting never became pregnant after transplantation.
After updating the overall data on ovarian tissue transplantations in the German FertiPROTEKT network, the success rates
with regard to the restoration of the endogenous function are up
to 93%, the clinical pregnancy rates are around 47%, and the live
birth rate approximates 35–43% [1, 3, 11].
Meanwhile the benefit of cryopreservation of ovarian tissue has
been shown for prepubertal girls, too [3, 17, 18], even after considering the risks associated with gonadotoxic therapy and surgery.
Ovarian tissue that was initially derived from prepubertal ovaries
resulted in more than ten live births worldwide following later
transplantation at adolescence. Further, there are published reports
that prepubertal tissue can successfully induce puberty if transplanted to girls with persisting primary amenorrhea [17, 19–
21]. The importance of fertility preservation for this young patient
group is discussed in detail by Tuppi et al. [22]. Even though the
prepubertal ovaries show no regular follicle activity, they are considerably affected by DNA damage from gonadotoxic substances,
which sooner or later will result in atresia [22]. The fact that
children have a much higher ovarian cortex potential than adolescent or adult patients of reproductive age usually gives a wrong
perception of the extent of the damage that will be caused by
gonadotoxic therapies. These female children largely enter puberty
after gonadotoxic therapy. However, if the number of the remaining, non-damaged follicles is ultimately sufficient up to the time of
the fertile phase to conceive and to achieve a pregnancy, must be
critically questioned and is often disproved in practice.
2 Materials
2.1 Medium
for Transportation,
Preparation,
and Cryopreservation
of Ovarian Tissue
All materials need to be sterile and handled under sterile conditions.
1. Custodiol, 500 mL (Dr. Franz Ko ¨hler Chemie, Bensheim,
Germany). Medium is ready to use for transportation and
preparation. It should be stored at 4
C.
2. Multipurpose Handling Medium-Complete (MHM-C),
500 mL (FUJIFILM Irvine Scientific, Santa Ana, CA, United
States), store at 4
C.
3. CryoSure-DMSO (i.e., >99.9% USP Grade DMSO), 50 mL
(WAK-Chemie Medical GmbH, Steinbach/Ts., Germany),
store at 4
C, as medium for cryopreservation.
486
Jana Liebenthron and Markus Montag