Duke Health is at the forefront of regional and national efforts to advance fertility preservation options for people at risk of future infertility due to a medical condition or treatment such as chemotherapy or radiation. The fertility preservation team at Duke is one of the only programs in the Southeast United States to offer ovarian tissue cryopreservation (OTC). OTC may be a viable alternative for anyone not eligible for, or interested in, oocyte or embryo freezing, including people who are too ill to delay treatment of their primary condition for the 10 to 14 days of hormone stimulation required for these procedures. 

“OTC is unique in that it is also the only fertility preservation option available to those who have not yet gone through puberty, including children who are diagnosed with cancer or another fertility-limiting condition,” says Tara Streich-Tilles, MD, MPH, director of Pediatric and Adolescent Gynecology and co-director of Fertility Preservation at Duke.

In OTC, all or part of one ovary is removed, typically through laparoscopic abdominal surgery. The ovarian cortex is then frozen into strips and preserved for future use. Later, when biologic fertility is desired, the frozen ovarian tissue strips can be placed into the body with a second surgery, allowing patients to attempt natural conception or conception with additional assisted reproductive technologies. Research is ongoing to explore other ways this tissue may be used for biologic fertility.

The multi-disciplinary fertility preservation team at Duke includes fertility specialists, oncologists, hematologists, patient navigators, nurses, lab specialists, social workers, psychologists, financial counselors, and more, all working together to support an individual’s fertility journey. The program at Duke is also part of a national collaborative focused on research and clinical outcomes for fertility preservation in general and OTC specifically.

OTC is a potential fertility preservation option for anyone with ovaries at risk of future infertility, but especially those who may not be eligible for other fertility preservation procedures. This includes:

• Infants and children who have not gone through puberty
• People with cancer who need cancer treatment to begin immediately
• People with hormone-sensitive cancers
• People with a high risk of developing thromboembolism from high hormone levels

Streich-Tilles emphasizes that fertility preservation conversations need to start as early as possible in a patient’s diagnosis and treatment journey to give them as many options as possible with enough time to make the decisions that are right for them. “We want to collaborate throughout the patient’s treatment journey based on their unique needs. We are incredibly invested in having conversations about the risk to fertility of different conditions and treatment, and empowering patients with that knowledge, regardless of whether they decide to pursue fertility preservation.” 

The Duke fertility preservation team also cares for patients after treatment to provide fertility preservation, ovarian hormone function and reserve monitoring, hormone replacement therapy, and infertility treatment, as appropriate.