Key message
Cryopreservation of ovarian tissue for fertility preservation produces future-oriented hope and reproductive possibilities for young women
Future fertility has been found to be of high importance to oncological patients (Schover, 2009; Hohmann et al., 2011; Inhorn et al., 2017; Oktay et al., 2018; Parton et al., 2019) and infertility induced by cancer treatment is a source of distress for many cancer survivors (Armuand et al., 2014; Logan et al., 2019). In most centres, cryopreservation of embryos and oocytes are established techniques clinically available for fertility preservation, whereas ovarian tissue cryopreservation (OTC) has been perceived as an experimental procedure until recently (Penzias et al., 2019). For prepubertal girls and for young women for whom gonadotoxic treatment is urgent and poses a high risk of ovarian failure, however, OTC is the only fertility-preserving option (Donnez and Dolmans, 2018). The procedure is gaining ground worldwide, and thousands of girls and young women diagnosed with cancer or other life-threatening diseases have undergone OTC. More than 360 ovarian tissue transplantations have been reported worldwide, with 95% of women regaining ovarian endocrine function and over 130 children born (Gellert et al., 2018; Donnez and Dolmans, 2018). In contrast to the freezing of oocytes and embryos, ovarian tissue transplantation (OTT) holds the possibility of restoring fertility and hormone production, and provides women with a chance of spontaneous conception. As will be discuss in the present study, OTT involves a number of safety concerns (Dolmans and Masciangelo, 2018) and subjects patients to possible medical risks in ways that have not yet been investigated from the patientʼs perspective.
Most research to date on patient experiences with medical fertility preservation has focused on the decision-making process and the fertility counselling provided to women with cancer who are considering or opting for fertility preservation (Hoeg et al., 2016; Inhorn et al., 2017; Jones et al., 2017). Meanwhile, surviving patients’ reflections on, and experiences with, putting stored reproductive material to use have only been addressed to a limited extent (Parton et al., 2019), and only a few studies have looked at ovarian tissue freezing and transplantation from a patient perspective (Hoeg et al., 2016; Kroløkke et al., 2020). Furthermore, from a social science perspective, medical fertility preservation has been discussed in terms of what Franklin (1997), in her early work on IVF, termed ‘hope technology’ (Inhorn et al., 2017; Kroløkke et al., 2020). Inhorn et al. (2017), however, have also emphasized how fertility preservation should be approached as a Janus-faced technology as women with cancer invest their hope in a situation filled with much uncertainty, in terms of their survival and the success of achieving a live birth from the frozen material.
In Denmark, OTC has been offered clinically since 1999 and, to date, almost 1300 Danish girls and young women have had their ovarian tissue frozen. More than 100 women have returned and undergone OTT. In this qualitative study based on in-depth qualitative interviews with 42 Danish women who have gone through OTC, and of whom 32 subsequently underwent OTT, women's experiences with OTC and transplantation are explored, including the women's reflections on the decision-making process and fertility counselling, and the ways in which the possibilities and especially the risks associated with OTT inform the women's reproductive journeys and considerations about stored tissue.
The present study is based on qualitative in-depth interviews conducted between 2017 and 2019 by the first author with 42 Danish women who had OTC. In 32 of the cases, the participant also underwent OTT. The recruitment strategy was twofold. First, invitations to participate were distributed in groups for cancer patients, especially youth groups, who shared the invitation, for instance, on social media platforms (11 recruited). After obtaining permission from the Danish Patient Security
In this section, central elements of the patients’ accounts of preserving ovarian tissue and having it transplanted are delineated as well as their reflections on having ‘something in the bank.’ The results section is structured chronologically, beginning with the decision to freeze and considerations about having tissue stored. The analysis then moves to OTT where specific attention is paid to the risks experienced around post-cancer reproduction and the pursuit of motherhood. The question of
To the best of our knowledge, this is the first study to examine how Danish women have perceived and experienced OTC and the subsequent use of frozen ovarian tissue to pursue a chance of motherhood or restore hormonal cycles. The ovarian tissue produced a range of opportunities but also caused worry connected to the transplantation of the frozen tissue, which is distinctly different from patients having oocytes or embryos cryopreserved. In this way, the study testifies to the complexity and
A huge thank you to all the women who told their stories and shared their experiences. Thanks also to The Independent Research Fund Denmark (grant #7013-00042B) for funding this study, and to The Ice Age research group for their helpful comments on the first draft of the article.
Anna Sofie Bach is a postdoctoral researcher at the Department for the Study of Culture, University of Southern Denmark. She has a PhD in Sociology from the University of Copenhagen. Her work on ovarian tissue freezing is part of the interdisciplinary project Ice Age: Enthangled Lives, Times, and Ethics of Fertility Preservation. Key message Cryopreservation of ovarian tissue for fertility preservation produces future-oriented hope and reproductive possibilities for young women
Moreover, study patients maintained ovarian tissue storage even if they did not have any plans for parenthood at the time of the follow-up and even if they managed to get pregnant after treatment. The data are not surprising because women consider their cryopreserved ovarian tissue as an ‘insurance policy’ or ‘backup’ and want to retain power over their reproductive choices (Bach et al., 2020). Almost 30% of patients decided to stop storage of cryopreserved ovarian tissue and more than 50% of them had a live birth after treatment (Jadoul et al., 2017).
Also, Zhang proposed freezing of the human ovarian tissue in 1955 [10]. OTC is a ‘hope technology’ compared to embryos and oocyte freezing, but ovarian tissue is interlinked with risk and disease, and there is a possibility of cancer recurrence [11]. There are three common techniques for OTC, including vitrification, slow-freezing, and ultra-rapid freezing [12].
Anna Sofie Bach is a postdoctoral researcher at the Department for the Study of Culture, University of Southern Denmark. She has a PhD in Sociology from the University of Copenhagen. Her work on ovarian tissue freezing is part of the interdisciplinary project Ice Age: Enthangled Lives, Times, and Ethics of Fertility Preservation. Key message Cryopreservation of ovarian tissue for fertility preservation produces future-oriented hope and reproductive possibilities for young women facing potentially sterilizing treatment. Transplantation of frozen ovarian tissue, however, is interlinked with scenarios of risk and disease, which emphasize the importance of follow-up and fertility counselling in these patients after treatment has ended.