Novel use of the ovarian follicular pool to postpone menopause and delay osteoporosis

Abstract

Life expectancy has increased by more than 30 years during the last century and continues to increase. Many women already live decades in menopause deprived of naturally produced oestradiol and progesterone, leading to an increasing incidence of menopause-related disorders such as osteoporosis, cardiovascular diseases and lack of general well-being. Exogenous oestradiol has traditionally been used to alleviate menopause-related effects. This commentary discusses a radical new method to postpone menopause. Part of the enormous surplus of ovarian follicles can now be cryostored in youth for use after menopause. Excision of ovarian tissue will advance menopause marginally and will not reduce natural fertility. Grafted tissue restores ovarian function with circulating concentrations of sex steroids for years in post-menopausal cancer survivors. Future developments may further utilize the enormous store of ovarian follicles. Currently, the main goal of ovarian cryopreservation is fertility preservation, but grafting of ovarian tissue may also serve endocrine functions as a physiological solution to prevent the massive medical legacy of osteoporosis and menopause-related conditions in the ageing population. This intriguing solution is now technically available; the question is whether this method qualifies for postponing menopause, perhaps initially for those patients who already have cryostored tissue?

The development of ovarian tissue cryopreservation in Edinburgh: Translation from a rodent model through validation in a large mammal and then into clinical practice

“…The issue of tissue contamination with malignant cells also remains a significant concern, and although successful pregnancies have been reported in women with leukemia with tissue stored after initial therapy, this remains a major concern to many working in the field. The restoration of endocrine function of the replaced ovary is an additional benefit, and it has been proposed that this may be a distinct indication separate from fertility: the risks and benefits of this approach compared with conventional menopause hormone treatment have not been investigated . An extension of this is replacement for pubertal induction, and although this has been reported, there are significant concerns with that indication because the rapid estrogenization and early progesterone exposure are contrary to established principles of induction of puberty .…”

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“…Studies first would have to show that the transplanted ovarian tissue could function for at least five years. Cryopreserved Ovarian Tissue can be used to post-pone and alleviate menopausal symptoms [8].…”

Ovarian Tissue Cryopreservation / Transplantation for Social Reasons: Between (“Good”) Medicalization and Medical Treatment.

“…Besides, nowadays, human life expectancy is remarkably expanding and this indication is taken seriously into account by current bioethical literature, regarding either fertility [10] or endocrine ovarian function lifespan [107] prolongation.…”