In a first, a Malaysian medical team has successfully completed a pre-pubertal ovarian tissue cryopreservation (OTC) to preserve the fertility of a courageous six-year-old Russian cancer patient.
-Advertisement-
The procedure was carried out recently under the guidance of Hospital Canselor Tuanku Mukhriz UKM consultant obstetrician and gynaecologist Associate Professor Dr Mohd Faizal Ahmad.
The patient has neuroblastoma, a cancer that develops from immature nerve cells found in several areas of the body.
Given the urgency of the situation, one of the young girl’s ovaries was harvested and transported from a private hospital in Singapore to a private fertility centre in Malaysia on the same day.
Utilising state-of-the-art technology, Assoc Prof Faizal and his team meticulously sliced and preserved the ovarian tissues, thus safeguarding the patient’s fertility against her cancer treatments, which include chemotherapy and radiotherapy.
“The most challenging aspect was that the tissue was harvested from another medical facility located more than seven hours of driving distance away.
“Therefore, we had to activate transportation protocols to ensure the preservation of the tissue prior to the cryopreservation process.
“The protocol involved maintaining the tissue in at least -4 degrees Celsius or below, using a special device within a special media,” explains Assoc Prof Faizal, who has an interest in reproductive endocrinology and oncofertility.
As the side effects of chemotherapy can damage the ovarian tissue, leading to premature menopause and inability to conceive in future, the patient’s parents decided to preserve their child’s fertility as her prognosis was good.
As to why the patient’s family decided to do the OTC procedure in Malaysia when the treatment is being carried out in Singapore, the consultant says the information is confidential.
The age criteria for OTC depends on individual fertility centres, although Assoc Prof Faizal says it’s best that the patient is at least five years old.
“The youngest I have seen is at six months old when I was training overseas,” he shares.
There are no direct side effects related to single ovarian removal because the other ovary will still be functioning,
The ideal time to return the ovarian tissue to the body is within two years of cancer remission, which must be confirmed and agreed upon by the primary oncologist.
Assoc Prof Faizal says: “Usually, the ovarian tissue transplantation (OTT) will be performed via laparoscopy.
“The OTT involves reimplanting the thawed tissue at the remnant of the ovarian fossa, muscle, or even anterior abdominal wall.”
Most of the tissue can be stored for at least 10-15 years, although some European centres have already preserved such tissue for as long as 18 years.
OTC-reported pregnancies reported worldwide have varying success rates, ranging from 35% to 45% for live births.
“More than 500 pregnancies and deliveries have been reported worldwide.
“However, in Malaysia, no pregnancy has been reported yet as we only started our OTC programme in 2020.
“Our patients are mostly in the 15-18 years age group, so we have to wait another 10 years for an OTT.
“We are waiting excitedly to see our own progress,” he says.
-Advertisement-
Becoming mainstream
According to consultant obstetrician and gynaecologist, and fertility specialist, Dr Aldrin Lie, “Every woman is capable of producing a finite number of eggs in her lifetime, and the quality and quantity of these declines with age.
“The sharpest decline occurs after the age of 35.
“While it’s not impossible to conceive at a later age, it can be a harder process for many.”
Egg freezing has become such a mainstream idea that it’s now part of an employee’s perk in some companies in the United States.
He points out: “In so many other areas of healthcare, we’re proactive – we watch our diets and stay fit to keep chronic disease at bay.
“Yet, with fertility, we tend to only take action when a problem arises.
“Methods like egg and sperm freezing give people an option of increasing their odds.”
Also known as oocyte cryopreservation, egg freezing involves retrieving and storing a woman’s eggs in order to be used for conception at a later time.
The method was first introduced in the 1980s as a way of offering women with serious medical conditions a chance at having children after completing treatment for their illness.
The first human birth from a frozen oocyte was reported in 1986.
Since then, the technology has advanced significantly, with improved overall success of eggs surviving the freezing process.
The procedure involves undergoing a series of tests to assess the woman’s ovarian reserve (the total number of healthy eggs in the ovaries).
If the results are good, the patient will then undergo ovarian stimulation.
This requires hormone injections for around two weeks to help the ovaries produce more eggs.
“On average, a woman will release one egg per month during their ovulation cycle,” says Dr Lie.
“By encouraging a greater number of eggs, we have a better chance of retrieving ones that are suitable for future use, and have a greater reserve of usable eggs when they’re ready to be thawed.”
Once the eggs have matured, they are collected from the ovaries via a transvaginal procedure.
This involves using a fine needle attached to an ultrasound- guided probe, which is gently passed through the vagina, womb and into the ovaries.
Dr Lie assures that the process is pain-free as the patient is usually lightly sedated.
The final step is vitrification, a specialised procedure where the eggs are rapidly frozen using substances that prevent ice crystals from forming.
According to him, the eggs can be stored for up to 10 years, ready to be dethawed when a couple is ready to embark on their journey to parenthood.
-TheStar