Authors (including presenting author) :
Ng K (1)(2)(3), Wong HY (4), Ip NPP (1)(2)(3), Chan YLD (2), Chung PWJ (1)(2)
Affiliation :
(1) Department of Obstetrics and Gynaecology, Prince of Wales Hospital (2) Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong (3) Department of Paediatric Adolescent Gynaecology, Hong Kong Children’s Hospital (4) Department of Paediatric Surgery, Hong Kong Children’s Hospital
Introduction :
Ovarian tissue cryopreservation (OTC) represents a groundbreaking approach in fertility preservation, specifically tailored for individuals facing medical treatments or conditions that jeopardize their reproductive potential. This service is especially crucial for prepubertal girls, who are not suitable for oocyte cryopreservation, and patients who cannot undergo the hormonal stimulation necessary for egg freezing due to time constraints before gonadotoxic treatment. By preserving ovarian cortical tissue, which contains primordial follicles, OTC offers a dual benefit of maintaining endocrine function and fertility for future use. This review highlights the establishment of the first OTC centre in Hong Kong. It examines the indications for OTC, advances in the procedure, clinical outcomes, and ethical considerations. The discussion also focuses on its application in vulnerable populations and its significance in driving innovation in fertility preservation.
Objectives :
To review the implementation and outcomes of a multidisciplinary ovarian tissue cryopreservation program.
Methodology :
The OTC program was introduced in Hong Kong in November 2023. Eligible patients, referred by oncologists, underwent a multidisciplinary evaluation involving oncologists, paediatric endocrinologists, and gynaecologists to receive counselling and determine their suitability for OTC. An analysis was carried out on all cases performed since the program was introduced at the Prince of Wales Hospital and the Hong Kong Children’s Hospital. Information regarding patient demographics, clinical presentation, and surgical outcomes was retrieved from medical records.
Result & Outcome :
A total of nine cases were included in this review, with a mean referral age of 11 years (range: 2–16 years). Ovarian tissue harvesting was performed prior to the initiation of chemotherapy in all cases. Of these, five patients required chemotherapy for malignant conditions, while four underwent OTC prior to stem cell transplantation for Thalassaemia. Unilateral salpingo-oophorectomy was performed for prepubertal patients, whereas ovarian cortical tissue was harvested for post pubertal individuals. On average 13 (range: 5-37) pieces of ovarian tissue were obtained per patient and were all cryopreserved using the slow-freezing method. Histopathological examination confirmed the absence of malignancy in all samples. No intraoperative or postoperative complications were reported. To date, none of the patients have returned for ovarian tissue transplantation yet. Conclusion The successful implementation of an ovarian tissue cryopreservation program demonstrates its feasibility as a safe and effective fertility preservation option for paediatric and adolescent patients undergoing gonadotoxic therapies. This program provides a vital opportunity to safeguard future reproductive potential in this vulnerable population.
