Assessing the clinical effectiveness of transplanting ovarian tissue

Khattak, Hajra Mumtaz (2023). Assessing the clinical effectiveness of transplanting ovarian tissue. University of Birmingham. Ph.D.

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Abstract

Aim: To assess the clinical effectiveness of ovarian transplantation in returning reproductive and hormonal function in females.

Methods: Three research methods were applied; 1) evidence synthesis using a systematic review and individual patient data (IPD) meta-analysis, and a systematic review and thematic analysis of qualitative studies, 2) an observational case series and 3) a qualitative thematic analysis study.

Results: The results of systematic review and IPD meta-analysis demonstrated that ovarian tissue cryopreservation (OTC) and transplantation could restore reproductive and hormonal functions in women. The results were significant in females preserving ovarian tissue under the age of 35 years. Through thematic syntheses of studies exploring the experiences of females who had undergone ovarian tissue cryopreservation and transplantation, the experiences were described as emotional, involving complex decision-making, helping them prepare for the long-term consequences of potentially losing their fertility and hormonal function, as well as the OTC procedure being informative. Themes generated as a result of the qualitative interview study showed that women are very keen to have OTC as additional option of fertility preservation. The procedure has its drawbacks in that it is expensive and requires two surgeries nevertheless participants felt it should be offered to young girls and women in whom OTC may be the only option of fertility preservation. Participants with previous cancer who had become menopausal after gonadotoxic cancer treatment, were grateful for the hormonal function from the ovarian transplants. Furthermore, fresh ovarian transplantation in women who underwent bilateral oophorectomy, showed an increase in oestrogen post-transplant. Fresh ovarian transplants could therefore potentially be beneficial in a select group of women in whom HRT is not an option or they prefer not to take it, to help with symptoms of iatrogenic menopause.

Conclusion: Although being developed for over two decades, ovarian tissue cryopreservation and transplantation is still deemed experimental in most parts of the world. Through this thesis it is demonstrated that many young girls and women can benefit from fertility and hormonal preservation using both fresh and frozen thawed ovarian tissue transplantation.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):