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In the early days of 2024, the prestigious scientific journal American Journal of Obstetrics & Gynecology published the results of a study to determine the feasibility of cryopreserving ovarian tissue in order to delay menopause. "For the first time in the history of medicine, we have the ability to potentially delay or eliminate menopause", said Dr Kutluk Oktay, author of the study and Director of the Laboratory of Molecular Reproduction and Fertility Preservation at the Yale School of Medicine (USA).
Since the first cryopreservation of ovarian tissue by the same biologist in 1999, the - effective - use of this technique has been limited to patients under 40 years of age whose chemotherapy or radiotherapy treatments threatened to impair their fertility. Practically, the operation consists in laparoscopic removal of the ovary or the outer layers of the ovary containing a large number of immature oocytes (primordial follicles). This tissue is then frozen at -195°C. Once the ovarian tissue has thawed, the surgeon re-implants it into the patient. A few days later, the tissue's connection with the blood vessels is restored. The ovarian function is generally restored within three months. The younger the woman, the greater the chance that ovarian function will be restored. As well as preserving the fertility of women undergoing the aforementioned treatments, this operation can significantly delay menopause if the sample is taken before the age of 40, or even eliminate it if the sample is taken before the age of 30.
Ethical considerations
It should be noted that the ovarian tissue cryopreservation technique does not require subsequent recourse to in vitro fertilisation, as is the case for oocyte retrieval. Once the ovarian tissue has been re-implanted and its function restored, the woman will be able to conceive naturally. The problematic consequences of in vitro fertilisation from an ethical point of view, such as the instrumentalisation of human embryos, are therefore not present in this case.
Nevertheless, it is necessary from an ethical point of view to distinguish the use of cryopreservation of ovarian tissue for medical reasons (preservation of fertility when faced with treatments hostile to the reproductive organs) carried out with respect for the woman's biological rhythm, on the one hand, and the use of this technique to avoid menopause - which in no way constitutes a pathology for the woman - on the other. Indeed, as Julio Tudela and Cristina Castillo of the Bioethics Observatory at the Catholic University of Valencia put it, "we must ask ourselves whether it is desirable to extend a woman's fertility beyond the physiological period, by authorising further pregnancies at an advanced age, which would entail significant risks for the health of the woman and her child". In addition to concerns about pregnancies at an advanced age, there is also the question of the child's social and psychological balance.