Ovarian tissue and ovarian suppression

They are two further ways of trying to protect a woman's fertility, used when egg or embryo freezing is not possible or as an addition to it. Ovarian suppression uses monthly or three-monthly hormone injections, started shortly before chemotherapy and continued during treatment, to put the ovaries into a temporary resting state. The idea is that resting ovaries may be less vulnerable to damage. Evidence is strongest for women with breast cancer, where studies suggest it may reduce the chance of early menopause, but results are mixed for other cancers, and it does not replace egg or embryo freezing. It does not delay treatment and can be considered even when there is no time for other options.

Ovarian tissue freezing involves removing one ovary, or part of it, through keyhole surgery before treatment. The outer layer, which contains many immature eggs, is cut into thin strips and frozen. Years later, when a woman wants to become pregnant, the tissue can be thawed and transplanted back, where it may restore hormone production and fertility for a period. Pregnancies have been reported worldwide, and in some countries it is no longer considered experimental. It can be done quickly, does not need hormone stimulation, and is the only option for girls before puberty. However, it requires surgery, is available only in a few specialised centres in India, and for some blood cancers there is a concern that cancer cells could be present in the stored tissue.

Your oncologist and a fertility specialist can explain whether either option is suitable. Because both are less widely available and the evidence is still developing, it is reasonable to ask about benefits, risks, costs and where they are offered.

Suppression can cause menopause-like symptoms

Hot flushes, sweats and mood changes are common while injections continue, and usually ease afterwards.

Tissue freezing needs a short operation

Keyhole surgery under general anaesthetic, usually as a day case or short stay.

Both can be combined with other options

Some women freeze eggs and also have suppression during treatment.

It cannot tell you whether either option will protect your fertility. Evidence is still developing, and results vary between people and cancers. Your specialists can explain what is known for your situation.

It also cannot tell you where these options are currently offered. Availability changes, so ask your oncology team for up-to-date information.

Suppression is not a substitute

Where there is time, egg or embryo freezing is usually recommended alongside or instead of suppression.

Blood cancers and tissue freezing

In leukaemia and some lymphomas, stored tissue could contain cancer cells. Specialists assess this risk carefully.

Girls before puberty

Tissue freezing is the only established option. Parents should ask early whether it is possible.

Hormone-sensitive cancers

Suppression is sometimes also part of breast cancer treatment itself. Your oncologist will explain both purposes.

Consent and storage

Stored tissue needs consent, storage fees and careful records, as for eggs and embryos.

Emotional support

Deciding about surgery or injections quickly is stressful. Counselling helps.

How ovarian suppression is given

Ovarian suppression is usually given as an injection under the skin of the tummy, started shortly before the first chemotherapy cycle and repeated at intervals throughout treatment. The injections reduce signals from the brain to the ovaries, so the ovaries stop maturing eggs and producing oestrogen. Periods usually stop while injections continue. When chemotherapy ends and injections stop, the ovaries may resume working, although chemotherapy may still have reduced the egg supply. Your team will explain the schedule and what to expect.

Evidence in breast cancer and other cancers

The strongest evidence for ovarian suppression comes from studies of young women with breast cancer, where it appears to reduce the chance of early menopause after chemotherapy. Evidence in lymphoma and other cancers is less clear, and some studies have shown little benefit. International guidelines generally suggest it can be offered when egg or embryo freezing is not possible, or as an addition, but it should not be relied on as the only method when other options are available.

What tissue freezing surgery involves

Ovarian tissue freezing is usually done by keyhole surgery under general anaesthetic. The surgeon removes one ovary or part of one through small cuts in the tummy. Most people go home the same day or the next day, with mild pain for a few days. If another procedure needs an anaesthetic, such as port insertion, the two can sometimes be combined. The tissue is taken to a laboratory, prepared into thin strips and frozen. Chemotherapy can often start within days.

Using stored tissue later

When a woman is ready to try for a pregnancy, and her oncologist agrees it is safe, the tissue is thawed and transplanted near the remaining ovary or elsewhere in the pelvis in another operation. If it takes, hormone production may return, periods may restart and natural conception or IVF may become possible. The tissue does not last forever, and results vary, so specialists will explain what can realistically be expected.

What to do next

Ask whether suppression or tissue freezing suits your cancer, where tissue freezing is available, what the risks and costs are, whether egg or embryo freezing is still possible, and how each option fits your treatment timeline.