Last week, in one of the clinics of the economic capital, the very first cryopreservation of the ovary in Morocco took place on an 18-year-old girl suffering from a brain tumor. Professor Jihane Toughza, pediatric oncologist and hematologist who is at the origin of this laudable initiative, gives us the details of this surgical intervention.
ALM: You initiated the first cryopreservation of the ovary in Morocco. Explain to us, Professor Toughza, what this intervention consists of?
Professor Toughza: Before explaining the technique of cryopreservation of the ovarian cortex, I would like to talk to you about what I experienced as an oncologist and hematologist and as a Moroccan woman. Since the beginning of my medical practice in Morocco, I always felt a certain guilt towards these young girls who require bone marrow transplants or high-dose chemotherapies for their treatment with significant gonadotoxicity, since infertility and hormonal dysfunction ovarian were part of the price to pay for a cure. Indeed, their personal history was forever marked, and they did not have access to this “right to forget the illness” that we doctors repeated to them each time they visited our follow-up consultations since cure of the disease was obtained. This feeling of guilt was all the more marked because during my practice in France, fertility preservation was systematically proposed and carried out for these patients. I had this feeling of dissatisfaction, and the impression of unfinished work, since there was an inequality of care depending on the geographical region where we were born. I therefore called on my dear sisters and brothers, national and international experts in the field of onco-fertility, onco-gynecologist surgeons and fertility biologists to do what was best in France. .
Ovarian cortex cryopreservation is an existing fertility preservation technique and represents the only preservation technique for pre-pubescent girls. This is followed by an ortho-topic autograft of previously frozen ovarian cortex. Cryopreservation of the ovarian cortex begins with a surgical procedure, as minimally invasive as possible, carried out by a gynecological surgeon expert in laparoscopy, under general anesthesia, which generally lasts no more than twenty minutes. During the latter, an oophorectomy of the patient is performed. Subsequently, this ovarian tissue is frozen following specific protocols until it is decided to thaw them in order to transplant them to the patient; the latter then recovering its functionality. The main advantage offered by cryopreservation of ovarian cortex compared to oocyte freezing is that it does not require prior ovarian stimulation for which it is impossible to delay chemotherapy, which is the vital emergency for the patient.
In what cases is this approach used?
Cryopreservation of ovarian cortex and its posterior transplantation is a strategy for preserving fertility both in patients who are going to undergo gonadotoxic antineoplastic treatment, as well as those who wish to postpone the time of conception. This technique makes it possible to recover the functionality of the gonad with regard to fertility and also the production of female hormones which prevent early menopause.
The operation required a team of experienced doctors… Tell us more…
I spoke to Dr Achour Mohamed, expert in the field of onco-gynecology and minimally invasive gynecological surgery, as well as Dr Filali Mounir, biologist and expert in fertility preservation, who immediately joined the project. Several multidisciplinary consultation meetings with Professor Poirot Catherine, one of the pioneers of fertility preservation in France, as well as other colleagues, Dr Benamar Bahaa, fertility and reproduction biologist, Dr Benjelloune Majid, gynecologist, Dr Benhayoun, a fertility and reproduction biologist, took turns to lead to the treatment of this first patient, who had a medulloblastoma brain tumor.
What medical infrastructure does the medical staff need to carry out this intervention?
The structure requires a technical platform with operating theaters allowing minimally invasive gynecological surgical procedures to be carried out under general anesthesia, as well as equipped laboratories allowing cryopreservation of the ovarian cortex. Once removed in the operating room, the ovary is placed in a sterile tube containing a culture medium and it is quickly transported to the laboratory in ice to maintain a temperature at 4°C in order to limit ischemia. The ovarian medulla is removed in order to retain only the thinnest possible cortex. The cortex is then cut into fragments. Each fragment is frozen using a slow freezing protocol. The temperature drops gradually then immersion in liquid nitrogen at -196°C is carried out for storage in a cryogenic container.
As this is a new technique in Morocco, are you planning to raise awareness around the subject so that those affected can be aware?
All our patients deserve this type of care, to allow them to live their lives as future women and mothers as normal as possible. As my dear friend, Dr Achour Mohamed, would tell me, “they are cared for physically and mentally and the circle is now closed”. This technique must be part of the overall care of any patient, small or large, suffering from cancer with gonadotoxic doses of chemotherapy or radiotherapy.
How much does this intervention cost? Is it covered by insurance?
This technique is not yet covered by insurance since we have just carried out the very first one. It is up to us doctors to defend this noble cause so that all our patients can benefit from it. As this is a first in Morocco, the cost has not yet been really assessed.
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