Aspermia vs Azoospermia
Dr. Kate Dudek • September 11, 2022 • 5 min read
Many factors contribute to male infertility, including genetic defects, varicoceles, abnormal sperm production, health and fitness and environmental factors. For a detailed review on all these factors and more, click here.
Two conditions that frequently get confused are azoospermia and aspermia.
Azoospermia will be diagnosed if no sperm cells are detected in a sperm sample. It is usually due to a blockage in the male reproductive tract (obstructive azoospermia) or a testicular deficiency (non-obstructive azoospermia).
Aspermia is more colloquially known as ‘dry ejaculate’ and refers to a complete lack of semen expulsion. It is essentially an ejaculatory disorder and is broadly classified as either anejaculation, where the semen does not pass from the seminal vesicles, prostate and ejaculatory ducts into the urethra; or retrograde ejaculation, where the semen passes backwards into the bladder instead of moving in an antegrade direction. Treatment will depend on which type of aspermia is diagnosed.
Anejaculation
Anejaculation, the inability to transport semen, has various aetiologies. These include ejaculatory duct obstruction, pelvic trauma/surgery/radiation, neurological conditions, diabetes and stress. The most common treatment approach for men who have anejaculation with an intact ejaculatory reflex is penile vibratory stimulation, which is successful in restoring antegrade ejaculation in 65-83% of cases. Alternative options are prostatic massage and electroejaculation. These methods are all types of sperm retrieval and will be used in preparation for Assisted Reproductive Techniques (ARTs).
Retrograde Ejaculation
Retrograde ejaculation, an inability to ejaculate in the antegrade direction, will often be diagnosed if sperm is detected in the urine. Semen enters the bladder, instead of emerging through the penis during orgasm. Retrograde ejaculation is responsible for 0.4-2% of all cases of male infertility and is most often due to previous medications or surgical procedures that have caused the muscle of the bladder neck to relax. Neurological conditions and diabetes can also affect this area, resulting in retrograde ejaculation. This form of aspermia responds well to drug treatment; specifically, sympathomimetic drugs (stimulate the sympathetic nervous system), which are able to restore ejaculation in 50-100% of cases, with minimal, if any, side effects.
The outlook for men with azoospermia and aspermia
The reality is that azoospermia and aspermia both significantly reduce the likelihood of a man fathering a child. Whilst one is classified as a condition of abnormal sperm production and the other as an ejaculatory disorder, the treatment options for both can be similar. For non-obstructive azoospermia and anejaculation the favoured treatment approach is sperm retrieval followed by ARTs. Unfortunately ARTs are costly and can be emotionally stressful. They also involve the female partner undergoing artificial hormone stimulation and egg retrieval. Men who have obstructive azoospermia may respond well to surgical blockage removal, avoiding the need to go through sperm retrieval and ART; and men who exhibit retrograde ejaculation may respond well to medication.
The main thing is to establish exactly what is causing infertility and devise an appropriate treatment plan accordingly.
Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and menopause.
Get in touch if you have any questions about this article or any aspect of women’s health. We’re here for you.
Sources:
- Jungwirth A, et al. European Association of Urology (EAU) guidelines on male infertility. Arnhem, The Netherlands: European Association of Urology, 2015. Available at https://uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf [Accessed 31 March 2019].
- Mehta, A, and M Sigman. “Management of the Dry Ejaculate: a Systematic Review of Aspermia and Retrograde Ejaculation.” Fertility and Sterility, vol. 104, no. 5, Nov. 2015, pp. 1074–1081, doi:10.1016/j.fertnstert.2015.09.024.
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Some studies suggest that low WC or WHR is indeed associated with a regular menstrual cycle and appropriate amounts of estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/) during [ovulation](https://nabtahealth.com/glossary/ovulation/), which may suggest better fecundity. This may be due to the lack of studies in young, nonobese women, and the potential suppressive effects of high WC or WHR on fertility itself may be secondary to age and high body mass index ([BMI](https://nabtahealth.com/glossary/bmi/)). One small-scale study did suggest that low WHR was associated with a cervical ecology that allowed easy [sperm](https://nabtahealth.com/glossary/sperm/) penetration, but that would be very hard to verify. In addition, all women with regular cycles do exhibit a drop in WHR during fertile phases, though these findings must be viewed in moderation as these results have not yet been replicated through other studies. 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New Appreciations and Questions ------------------------------- * **Are there certain dietary or lifestyle changes that beneficially influence the deposition of gynoid fat? ** Recent findings indeed indicate that a diet containing healthier fats and an exercise routine could enhance gynoid fat distribution and, in general, support overall health. * **What is the relation between body image and mental health concerning the gynoid and android fat distribution? ** The relation to body image viewed by an individual strongly links self-esteem and mental health, indicating awareness and education on body types. * **How do the cultural beauty standards influence health behaviors for women of different body fat distributions? ** Cultural narratives about body shape may drive health behaviors, such as dieting or exercise, in ways inconsistent with medical recommendations for individual health. **References** 1.Shin, H., & Park, J. (2024). Hormonal Influences on Body Fat Distribution: A Review. Endocrine Reviews, 45(2), 123-135. 2.Roberts, J. S., & Meade, C. (2023). The Effects of WHR on Health Outcomes in Women: A Systematic Review. Obesity Reviews, 24(4), e13456. 3.Chen, M. J., & Li, Y. (2023). Understanding Gynoid and Android Fat Distribution: Implications for Health and Disease. Journal of Women’s Health, 32(3), 456-467. 4.Hayashi, T., et al. (2023). Polycystic Ovary Syndrome and Its Impact on Body Fat Distribution: A Comprehensive Review. Frontiers in Endocrinology, 14, 234-241. 5.O’Connor, R., & Murphy, E. (2023). Sex Hormones and Fat Distribution in Women: An Updated Review. [Metabolism](https://nabtahealth.com/glossary/metabolism/) Clinical and Experimental, 143, 155-162. 6.Thomson, R., & Baker, M. (2024). Body Image, Self-Esteem, and Mental Health: The Role of Fat Distribution. Health Psychology Review, 18(1), 45-60. 7.Verma, P., & Gupta, A. (2023). Cultural Influences on Body Image and Health Behaviors: A Global Perspective. International Journal of Environmental Research and Public Health ([MDPI](https://www.mdpi.com/journal/ijerph)), 20(5), 3021.
Causes of Female Infertility – Autoimmune and Immune-Mediated Disorders
Autoimmune diseases cause the body’s own immune system to generate auto-antibodies that attack and destroy healthy body tissue by mistake. The most common autoimmune diseases include rheumatoid arthritis, thyroid disease and [lupus](https://nabtahealth.com/glossary/lupus/). Many are associated with increased risk of miscarriages and [infertility](https://nabtahealth.com/glossary/infertility/). The reasons for this are not fully understood and differ between diseases, but are thought to be due to the altered immune response causing [inflammation](https://nabtahealth.com/glossary/inflammation/) of the [uterus](https://nabtahealth.com/glossary/uterus/) and [placenta](https://nabtahealth.com/glossary/placenta/). Medications commonly prescribed for autoimmune diseases can also affect reproductive function. 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Furthermore, it is hypothesised that in the 20% or more cases of idiopathic [infertility](https://nabtahealth.com/glossary/infertility/), where no direct cause can be identified, inflammatory processes may play a role. #### Thyroid Disease Autoimmune thyroid disease is a common condition in women of childbearing age affecting 5-15% and can [lead](https://nabtahealth.com/glossary/lead/) to either an overactive (Graves’ disease, [hyperthyroidism](https://nabtahealth.com/glossary/hyperthyroidism/)) or underactive (Hashimoto’s thyroiditis, [hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/)) thyroid. Women with thyroid disease often experience menstrual cycle irregularities, so may struggle to conceive. #### [Lupus](https://nabtahealth.com/glossary/lupus/) Systemic [Lupus](https://nabtahealth.com/glossary/lupus/) Erythematosus (SLE) is a long-term autoimmune disease causing [inflammation](https://nabtahealth.com/glossary/inflammation/) of the joints, skin and other organs. SLE affects approximately 1 in 2000 women of childbearing age and diagnosis of the condition seems to correlate with a reduction in pregnancy rates. Women with SLE frequently exhibit [irregular periods](https://nabtahealth.com/why-are-my-periods-irregular/). This might be due to their medication, but there is also evidence of disease-specific effects. Women with SLE are immunocompromised and therefore at increased risk of [infection-induced](https://nabtahealth.com/causes-of-female-infertility-infection) [infertility](https://nabtahealth.com/glossary/infertility/). There is a psychosocial element, as women who are diagnosed with SLE are at increased risk of stress, depression and reduced libido, all of which can make falling pregnant more difficult. One of the most established links between SLE and [infertility](https://nabtahealth.com/glossary/infertility/) relates to the [cytotoxic](https://nabtahealth.com/glossary/cytotoxic/) drugs used to treat the condition, for example, cyclophosphamide. Taken for prolonged periods, these drugs can cause ovarian failure. #### [Celiac Disease](https://nabtahealth.com/glossary/celiac-disease/) Around 1% of women in developed countries have the autoimmune condition [celiac disease](https://nabtahealth.com/glossary/celiac-disease/), where the ingestion of gluten leads to damage in the small intestine. They are at increased risk of [infertility](https://nabtahealth.com/glossary/infertility/) and recurrent [miscarriages](https://nabtahealth.com/pregnancy-after-miscarriage/). This is likely to be due to nutritional deficiencies in their diet. Thus, women with the condition may want to consult a nutritionist prior to attempting to start a family. #### Auto-antibodies The production of [autoantibodies](https://nabtahealth.com/glossary/autoantibodies/) is central to autoimmune disease. One in five infertile couples are diagnosed with unexplained [infertility](https://nabtahealth.com/glossary/infertility/) (UI) in which they are unable to conceive with no obvious cause. [Autoantibodies](https://nabtahealth.com/glossary/autoantibodies/) have been found to account for some cases of UI, examples include: * Anti-[sperm](https://nabtahealth.com/glossary/sperm/) antibodies ([ASAs](https://nabtahealth.com/glossary/asas/)) * Antibodies against the [thyroid gland](https://nabtahealth.com/glossary/thyroid-gland/), or cellular components such as the nuclear membrane or the cell membrane (phospholipid) * Antiovarian antibodies. Anti-[sperm](https://nabtahealth.com/glossary/sperm/) antibodies ([ASAs](https://nabtahealth.com/glossary/asas/)) have been detected in the [cervical discharge](https://nabtahealth.com/cervical-discharge-through-the-menstrual-cycle/) of infertile women, as well as in the seminal fluid of their male partner. [ASAs](https://nabtahealth.com/glossary/asas/) bind to [](https://nabtahealth.com/everything-you-need-to-know-about-sperm/)[sperm](https://nabtahealth.com/glossary/sperm/) cells, causing them to stick together (agglutinate) resulting in [reduced movement](https://nabtahealth.com/low-sperm-motility-asthenozoospermia/) and, in many cases, reduced cervical penetration and inhibition of [implantation](https://nabtahealth.com/glossary/implantation/). However, further research is required on determining exactly how [ASAs](https://nabtahealth.com/glossary/asas/) affect fertility, as [ASAs](https://nabtahealth.com/glossary/asas/) have also been found in the cervical secretions of fertile women. The majority of studies assessing the relationship between [ASAs](https://nabtahealth.com/glossary/asas/) and [infertility](https://nabtahealth.com/glossary/infertility/) are old and have used outdated technologies which may result in false-positive results due to cross reactivity with other antibodies. The evidence of the effects of antibodies against thyroid, or cellular components such as the nuclear membrane or phospholipid and antiovarian antibodies on fertility, like [ASAs](https://nabtahealth.com/glossary/asas/) is conflicted and requires further research. Furthermore, how antibodies can cause [infertility](https://nabtahealth.com/glossary/infertility/) is not fully understood, and all studies suggesting a link are more about association with [autoantibodies](https://nabtahealth.com/glossary/autoantibodies/) rather than a cause. Anti-[oocyte](https://nabtahealth.com/glossary/oocyte/) antibodies also exist, but these seem to be a lot less common.Anti-ovarian antibodies have been detected in women with [](https://nabtahealth.com/causes-of-female-infertility-failure-to-ovulate)[POI](https://nabtahealth.com/glossary/poi/). They are associated with anti-follicle-stimulating hormone ([FSH](https://nabtahealth.com/glossary/fsh/)) antibodies. [FSH](https://nabtahealth.com/glossary/fsh/) is involved in regulating ovarian function. [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-infection) [Infertility](https://nabtahealth.com/glossary/infertility/) – Infection ([PID](https://nabtahealth.com/glossary/pid/) and [HPV](https://nabtahealth.com/glossary/hpv/)) [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-environmental-lifestyle-factors) [Infertility](https://nabtahealth.com/glossary/infertility/) – Environmental/Lifestyle Factors Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#671e060b0b062709060513060f02060b130f4904080a) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Brazdova, A, et al. “Immune Aspects of Female [Infertility](https://nabtahealth.com/glossary/infertility/).” International Journal of Fertility & Sterility , vol. 10, no. 1, 2016, pp. 1–10. * Domniz, N and Meirow, D, “Premature ovarian insufficiency and autoimmune diseases” Best Practice & Research Clinical Obstetrics & Gynaecology, vol 60, Oct 2019, pp 42-55. doi.org/10.1016/j.bpobgyn.2019.07.008. * Hickman, R A, and C Gordon. “Causes and Management of [Infertility](https://nabtahealth.com/glossary/infertility/) in Systemic [Lupus](https://nabtahealth.com/glossary/lupus/) Erythematosus .” Rheumatology, vol. 50, no. 9, Sept. 2011, pp. 1551–1558., doi:10.1093/rheumatology/ker105. * Khizroeva, J et al, “[Infertility](https://nabtahealth.com/glossary/infertility/) in women with systemic autoimmune diseases” Best Practice & Research Clinical Endocrinology & [Metabolism](https://nabtahealth.com/glossary/metabolism/), vol 33, Dec 2019, doi.org/10.1016/j.beem.2019.101369. * Kim, N Y et al. “Thyroid autoimmunity and its association with cellular and humoral immunity in women with reproductive failures.” American Journal of reproductive immunology, vol. 65, no. 1, Jan. 2011, pp. 78-87. doi: 10.1111/j.1600-0897.2010.00911.x. * Lebovic and Naz, “Premature ovarian failure: Think ‘autoimmune disorder’”, Sexuality, Reproduction & [Menopause](https://nabtahealth.com/glossary/menopause/), vol. 2, no. 4, Dec 2004, pp.230-233. https://doi.org/10.1016/j.sram.2004.11.010. * McCulloch, F. “Natural Treatments for Autoimmune [Infertility](https://nabtahealth.com/glossary/infertility/) Concerns.” American College for Advancement in Medicine, 29 Jan. 2014, [www.acam.org/blogpost/1092863/179527/Natural-Treatments-for-Autoimmune-](http://www.acam.org/blogpost/1092863/179527/Natural-Treatments-for-Autoimmune-Infertility-Concerns)[Infertility](https://nabtahealth.com/glossary/infertility/)\-Concerns. * Romitti, M et al. “Association between [PCOS](https://nabtahealth.com/glossary/pcos/) and autoimmune thyroid disease: a systematic review and meta-analysis.” Endocrine connections, vol 7, no. 11, Oct 2018, pp 1158-1167. doi: 10.1530/EC-18-0309. * Shigesi, N et al, “The association between [endometriosis](https://nabtahealth.com/glossary/endometriosis/) and autoimmune diseases: a systematic review and meta-analysis.” Human Reproduction Update, vol. 25, no. 4, Jul 2019, pp 486-503. doi: 10.1093/humupd/dmz014. * “What Are Some Possible Causes of Female [Infertility](https://nabtahealth.com/glossary/infertility/)? .” National Institutes of Health, [www.nichd.nih.gov/health/topics/](http://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female)[infertility](https://nabtahealth.com/glossary/infertility/)/conditioninfo/causes/causes-female.
Freezing Ovarian Tissue: Could it be Used to Delay the Menopause?
The freezing of ovarian tissue, also known as **O**varian **T**issue **C**ryopreservation (OTC), is an experimental type of fertility preservation, used predominantly by female cancer patients who would otherwise likely become infertile following treatment. **How is OTC performed?** ------------------------- Part or all of the ovary is removed using [](https://nabtahealth.com/what-is-a-laparoscopy/)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/). If the entire ovary is removed it may be cryopreserved whole, otherwise it is cut into very thin slices, between 0.3 and 2mm, which are frozen and stored until required. The tissue is thawed and re-transplanted, either into the pelvic region (orthotopic) or elsewhere in the body (heterotopic). **Part vs whole ovary?** ------------------------ It is not always necessary to remove the whole ovary, although your doctor might choose to if they anticipate complete ovarian failure. Often only the outer layer will be taken, this is known as the ovarian cortex. There are a large number of immature eggs (oocytes) located in primordial follicles in this part of the ovary. This means that taking a small volume of tissue could potentially provide hundreds of oocytes for subsequent fertility treatment. The advantage of taking the whole ovary is that there is less chance of tissue ischemia (where the blood supply is decreased, resulting in reduced oxygen supply to the tissue), as blood flow can be maintained, or rapidly restored (revascularisation), using the vascular pedicle. Following re-transplantation, the vascular pedicle ensures adequate oxygenation of the transplanted tissue, reducing the likelihood of transplant failure. However, there can be challenges with cryopreserving it in its entirety and, if anything goes wrong, survival of the entire ovary could be compromised. **Slow freezing vs vitrification?** ----------------------------------- Work to establish the optimal method of freezing resected ovarian tissue is on-going. The most widely used method is the slow freezing of the tissue in a step-by-step process until it reaches -140°C, at which point it is stored in liquid nitrogen. Slow freezing reduces the formation of ice crystals, which can damage the ovarian cells. Vitrification is a newer technique that uses ultra-fast cooling with a higher concentration of cryoprotectant. It is quick and relatively easy to perform, with no requirement for expensive equipment. However, so far it is not widely used and there is limited data on its effectiveness. **Orthotopic vs heterotopic** ----------------------------- Determining the best transplant site for your cryopreserved ovarian tissue largely depends on your reason for undergoing OTC. If you hope to fall pregnant naturally, your only option is to undergo an orthotopic transplant. In this procedure the cryopreserved ovarian tissue is transplanted back into the pelvic region. Strips of tissue are transplanted either onto the surface of the remaining ovary, or into the pelvic peritoneum. The close proximity to the [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) means natural pregnancy is possible. However, the size of the transplant site restricts the number of fragments that can be transplanted. Menstrual cycles typically resume 4-9 months after OTC, which aligns closely with the time it takes for normal follicular growth and [oocyte](https://nabtahealth.com/glossary/oocyte/) maturity. This suggests that following OTC and re-transplantation the ovarian eggs start to develop normally. The lifespan of transplanted ovarian grafts is variable, the longest to date has been seven years. During a heterotopic transplant the ovarian tissue is re-transplanted elsewhere in the body. Frequently used sites are the forearm, abdomen wall and chest wall. Provided the transplant is successful, the transplanted ovarian tissue should start to produce hormones again, minimising any unwanted menopausal symptoms; however, pregnancy will only be possible using egg retrieval processes and artificial reproductive techniques/technologies (ARTs). The advantage to this type of transplant is that the graft can be placed in a location that allows for ease of access, so that maturing follicles can be monitored and retrieved if required for [IVF](https://nabtahealth.com/glossary/ivf/) and the transplanted tissue can be checked for signs of cancer recurrence. Aside from the fact that natural pregnancy is not possible following this type of transplant, the main disadvantage is that the transplanted tissue is less likely to survive due to difficulties reestablishing a blood supply. **Benefits to OTC** ------------------- For those women facing sudden, unexpected or premature ovarian failure, OTC provides an option for maintenance of fertility. Unlike embryo or egg freezing, where a complex harvesting process yields a “normal range” of 8-15 eggs per procedure; removing the ovarian cortex results in the harvesting of hundreds to thousands of immature oocytes. Furthermore, it is a simpler process, there is no need to wait for a particular time in the cycle and therefore, the procedure can be performed with minimal notice period. The additional benefit to this is that any cancer treatment is not delayed as a result. OTC is the only fertility preserving option for girls who have not yet gone through [](https://nabtahealth.com/what-is-puberty/)[puberty](https://nabtahealth.com/glossary/puberty/). This is because they do not yet have mature eggs to harvest directly. **Negatives to OTC** -------------------- Despite its potential, to date, OTC remains an experimental procedure. It is not yet endorsed by the American Society for Reproductive Medicine as a fertility preserving technique. There is hope that with more robust data, it will become more widely implemented in the clinical setting. There is a risk that re-transplanting grafted tissue will reintroduce unwanted malignancies. There is more chance of this with blood-borne cancers, such as the leukaemias. **Use of OTC for cancer patients** ---------------------------------- The nature of many types of cancer treatment means that they are toxic to [germ cells](https://nabtahealth.com/glossary/germ-cells/). Whilst chemoradiotherapy often does an excellent job of killing malignant cells, it can have a quite catastrophic effect on other cells of the body too. Learning that you have cancer and are likely to be rendered infertile by the treatment you receive is a huge psychological hurdle to overcome. In fact, the National Institute of Clinical Excellence (NICE) guidelines from the UK state that fertility preservation should be a part of the management of all cancer patients. OTC has the potential to be of significant benefit to those facing [cancer-induced](https://nabtahealth.com/causes-of-female-infertility-cancer/) [infertility](https://nabtahealth.com/glossary/infertility/). However, it might not just be a case of rectifying [infertility](https://nabtahealth.com/glossary/infertility/). Ovarian failure and a sudden drop in [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) production essentially places the body in a menopausal state. This triggers a range of symptoms that can be challenging to deal with both physically and emotionally, for example, [hot flushes](https://nabtahealth.com/glossary/hot-flushes/), difficulty sleeping, [vaginal dryness](https://nabtahealth.com/5-reasons-why-you-may-be-experiencing-vaginal-dryness/) and reduced libido. OTC following by orthotopic transplantation reestablishes normal ovarian activity in as many as 95% of cases. This has the potential to alleviate challenging menopausal symptoms, without the need to rely on hormone replacement therapy ([HRT](https://nabtahealth.com/glossary/hrt/)). **Alternative uses** -------------------- OTC is most strongly associated with the restoration of fertility in those who need to undergo life-saving, ovary-toxic cancer treatment. However, it has other potential uses for those with [benign](https://nabtahealth.com/glossary/benign/) disease, such as recurrent [](https://nabtahealth.com/can-endometriosis-make-it-harder-to-get-pregnant/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) and advanced [ovarian torsion](https://nabtahealth.com/what-is-ovarian-torsion/). It has the potential to be used prophylactically in those with a history of [primary ovarian insufficiency](https://nabtahealth.com/causes-of-female-infertility-failure-to-ovulate/) ([POI](https://nabtahealth.com/glossary/poi/)) or with [auto-immune diseases](https://nabtahealth.com/causes-of-female-infertility-autoimmune-and-immune-mediated-disorders/). There is also the option to use OTC as a means of postponing the [menopause](https://nabtahealth.com/glossary/menopause/). With life expectancy increasing, it is now estimated that a high number of women will spend a significant proportion of their life post-[menopause](https://nabtahealth.com/glossary/menopause/). There are certain risks associated with this from both a health and a quality of life perspective. Postmenopausal women are at greater risk of experiencing [](https://nabtahealth.com/osteoporosis-and-menopause/)[osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), cardiovascular disease and depression; and [HRT](https://nabtahealth.com/glossary/hrt/) is not suitable for everyone. Securely cryopreserving a large population of ovarian follicles, which when grafted back into the human body would start producing the female sex hormones, is one way to delay the onset of [menopause](https://nabtahealth.com/glossary/menopause/). However, whilst the idea makes sense in theory, as an experimental procedure, OTC is not currently endorsed to be used in this way. **Current status** ------------------ As described above, OTC has a lot of potential. So far the technique has resulted in more than 130 live births. There are technical challenges still to overcome. The protocols for freezing the resected tissue need optimising because current methods result in a lot of empty follicles, possibly as a result of ice crystal formation. Improving the viability of the follicles would increase the lifespan of the grafted tissue. There also needs to be further consideration of who could benefit from the procedure. Going forward, is this a feasible way of postponing the onset of the [menopause](https://nabtahealth.com/glossary/menopause/) for completely healthy women? Or, is it something that should be kept and optimised for use as a fertility preservation technique for those facing imminent, premature [infertility](https://nabtahealth.com/glossary/infertility/)? It is best if you try [](https://nabtahealth.com/product/perimenopause-test/)[Perimenopause](https://nabtahealth.com/glossary/perimenopause/) test to understand more on your health. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a0d9c1ccccc1e0cec1c2d4c1c8c5c1ccd4c88ec3cfcd) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Broekmans, Frank J. “Individualization of [FSH](https://nabtahealth.com/glossary/fsh/) Doses in Assisted Reproduction: Facts and Fiction.” _Frontiers in Endocrinology_, vol. 10, 26 Apr. 2019, doi:10.3389/fendo.2019.00181. * Donnez, Jacques, and Marie-Madeleine Dolmans. “Fertility Preservation in Women.” _New England Journal of Medicine_, vol. 377, no. 17, 26 Oct. 2017, pp. 1657–1665., doi:10.1056/nejmra1614676. * “[Menopause](https://nabtahealth.com/glossary/menopause/): Symptoms.” _NHS Choices_, NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/menopause/symptoms/)[menopause](https://nabtahealth.com/glossary/menopause/)/symptoms/. * “Ovarian Tissue Freezing.” _National Cancer Institute_, [www.cancer.gov/publications/dictionaries/cancer-terms/def/ovarian-tissue-freezing](http://www.cancer.gov/publications/dictionaries/cancer-terms/def/ovarian-tissue-freezing). * Rivas Leonel, Ellen Cristina, et al. “Cryopreservation of Human Ovarian Tissue: A Review.” _Transfusion Medicine and Hemotherapy_, vol. 46, no. 3, 9 Apr. 2019, pp. 173–181., doi:10.1159/000499054. * The Practice Committee of the American Society for Reproductive Medicine. “Ovarian Tissue Cryopreservation: a Committee Opinion.” _Fertility and Sterility_, vol. 101, no. 5, 31 Mar. 2014, pp. 1237–1243., doi:10.1016/j.fertnstert.2014.02.052.