Article
Futures and fears in the freezer: Danish womenʼs experiences with ovarian tissue cryopreservation and transplantation

https://doi.org/10.1016/j.rbmo.2020.06.009Get rights and content

Abstract

Research question

Ovarian tissue cryopreservation (OTC) and subsequent re-transplantation is gaining ground as a valid technique to preserve fertility in patients facing imminent cancer treatment. This study explores patients’ experiences with OTC and transplantation, including their reflections on long-term storage of tissue and the use of surplus tissue.

Design

Semi-structured qualitative interviews with 42 Danish women undergoing OTC between 2003 and 2018, 32 of whom had ovarian tissue transplanted.

Results

Overall, OTC was associated with positive experiences linked to the production of future-oriented hope and reproductive possibilities. It also generated a range of worries, particularly regarding hormone-sensitive cancers and the risk of re-transplanting malignant cells, and the womenʼs arduous journeys to conceive after cancer resonated through the accounts. Moreover, the women's understanding of, and access to, information about the OTC procedure and its prospects affected the ways in which they approached storage and transplantation of their frozen tissue. Finally, the interviews showed how the stored ovarian tissue was also infused with potentiality beyond the scope of reproduction, both as a remedy to restore hormonal cycles and in the imagination of the-yet-to-be-discovered potential informing the women's reflections on donation and destruction.

Conclusion

Although OTC is a ‘hope technology’ compared with freezing of oocytes and embryos, ovarian tissue is interlinked with risk and disease and positioned as an asset beyond the scope of reproduction. Importantly, this study underscores the need for provision of specialized information, follow-up, and fertility counselling after OTC and cancer treatment.

Introduction

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.

Section snippets

Materials and methods

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

Results

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

Discussion

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

Acknowledgements

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

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      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].

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    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.

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