Ovarian Tissue Cryopreservation for Fertility Preservation

The cure rate of cancer in children, adolescents and young adults continues to increase with advances in chemotherapy and/or radiation protocols. As more pediatric oncology patients become long-term survivors, the consequences of their treatment on their quality of life have become an important thrust of clinical oncology and basic science research. One of the most common and most devastating long-term sequelae following cancer treatment is infertility. Many chemotherapy and radiation-containing regimens for cancer therapy or prior to bone marrow transplantation can cause sterility in children and young adults. Fertility-preserving options are available for adult women (embryo freezing), but not all adult women are able to take advantage of this option since it requires fertilization. Some adult women are not able to cryopreserve embryos because they lack a partner or cannot delay treatment for the time required for ovarian stimulation. Currently, no fertility-preserving options are available for prepubescent girls who are not yet producing mature gametes and post-pubescent females whose follicular pool cannot be shielded from cancer therapy. However, experimental techniques are currently being developed to provide future alternatives for patients that preserve their ovarian tissue/cells prior to gonadotoxic treatment. In order to take advantage of these and future technologies, patients must harvest and preserve their ovarian tissue and/or oocytes (eggs) prior to the initiation of gonadotoxic therapy. This study will be available to girls and women from prepubertal years through 40 years of age who will undergo potentially sterilizing treatments. The primary objective of the proposed study is to develop techniques for long-term preservation of ovarian function through cryopreservation of ovarian tissue and/or cells prior to therapies that are likely to cause infertility (e.g., chemotherapy, radiation). This study will maintain cryopreserved ovarian tissue and/or cells for participating patients as a resource for future elective procedures to attempt fertility restoration. This study will also provide long-term follow-up on the fertility status of patients that will undergo a potentially sterilizing treatment for their primary disease or condition.

Fertility status has an important impact on the post-treatment quality of life for cancer survivors and other patients that receive gonadotoxic therapies (e.g., prior to bone marrow transplantation). Established fertility preserving therapies are available for adult women, but these therapies are not accessible or appropriate for all adult female patients. Currently there are no therapies to preserve the future fertility of preadolescent girls. However, new reproductive therapies are under development and may one day offer "fertile hope" to those survivors that do not currently have access to fertility preserving therapies. Clinical management of fertility-threatening diseases and treatments must have foresight of the gonadotoxic side effects and the potential for infertility. When no established fertility sparing options are available, it is reasonable to offer harvesting and cryopreservation of ovarian tissue as a possible means of fertility preservation. This study will provide a pool of research tissue that will be used to develop and test methods for manipulation and cryopreservation of ovarian tissue. Progress in these investigations may open up a range of new fertility preservation techniques to female patients that currently have no options. At the same time, a substantial portion of the patient's ovarian tissue will be cryopreserved and reserved for her own future use.

Inclusion criteria

• Be female age less than 40 years old.
• Unable or unwilling to make use of oocyte or embryo banking alone.
• Be scheduled to undergo surgery, chemotherapy, drug treatment and/or radiation for the treatment or prevention of a medical condition or malignancy with risk of causing permanent and complete loss of subsequent ovarian function.
• Or, have a medical condition or malignancy that requires removal of all or part of one or both ovaries.
• Or, Have newly diagnosed or recurrent disease. Those who were not enrolled at the time of initial diagnosis (i.e., patients with recurrent disease) are eligible if they have not previously received therapy that is viewed as likely to result in complete and permanent loss of ovarian function.
• Have two ovaries if undergoing elective removal of an ovary for fertility preservation only.

Exclusion criteria

• Diagnosed with psychological, psychiatric, or other conditions which prevent giving fully informed consent.
• Diagnosed with an underlying medical condition that significantly increases their risk of complications from anesthesia and surgery.