Unexplained Infertility
Anne-Marie Quirke • October 20, 2020 • 5 min read
Everybody’s experience of infertility is different, and this is just my own story. I guess it started when I got married in my early 30’s. Everything was going great, I loved my husband, my job and we were excitedly looking out for our dream home to buy together. We had decided jointly not to start a family until we had settled in our ‘forever home’, not really thinking my biological clock would be an issue! I had two close relatives with fertility issues, so I assumed I’d hardly be that unlucky to also have issues!
Finally, everything seemed to be in place the summer I turned 35. We had an active sex life geared towards conceiving, I ate more healthily, took vitamin supplements developed for women trying to conceive, and hoped and prayed that it should take no longer than 6 months to a year to fall pregnant. I had read in online literature that as I was over 30, I should expect it to take at least 6 months to fall pregnant. However, besides my relatively ‘older’ age I had no reason to suspect that we may have fertility issues. I had a healthy BMI and exercised regularly, I was fortunate to have a job I loved and no issues in my personal life to cause stress and I always had regular, reasonably heavy periods, without any associated issues to the best of my knowledge.
However, after 6 months of ‘trying’ there were no missed periods. We went to the GP, and were recommended to keep trying for another 6 months and then we would be referred to a specialist if I had not fallen pregnant, as I was over 35 at this stage and officially ‘geriatric’ in terms of getting pregnant, to my shock and horror! Another 6 months went by, and this time I was using urine ovulation test kits every month to try and predict the best window to ensure we were having sex at the right time. There were still no missed periods.
After a year of ‘trying’, we were referred to a gynaecologist, as I was now 35 turning 36. I had a number of blood tests taken, a trans-vaginal scan, a cervical smear test and a hysterosalpingogram (HSG) x-ray. My husband had a sperm test. All the results came back as “normal”, so we at least could rule out any issues with my husband, and I was diagnosed with ‘unexplained infertility’, which is not uncommon in women over 35. As an extra precaution, I had my ovarian reserve (number of eggs in my body) tested privately, by measuring anti-Mullerian hormone levels in my blood and that came out at ‘low’, to my slight alarm. However, my ovarian reserve results were more or less in line with what one would expect for someone at my age at the time.
In the first instance, for 6 months we were recommended to have intercourse every 2-3 days throughout my cycle. From day 2-6 of my cycle I was prescribed the oral medication clomiphene to promote ovulation. This is commonly prescribed to women who do not ovulate regularly or cannot ovulate at all.
After this period and with no pregnancy in sight, I had my follicles monitored for three months. This enabled the gynaecologists to identify the optimum time within my cycle for us to conceive. I had a transvaginal ultrasound at around day 10 of my menstrual cycle. My ovaries were monitored until a mature follicle had developed (greater than 16 mm endometrial thickness). When the egg was ready to be released from the follicle, I was asked to inject myself with human chorionic gonadotropin (HCG) to assist the process. We were recommended to have intercourse every 2-3 days throughout my cycle and increase this frequency around the time of ovulation. From day 2-6 of my cycle I was again prescribed the oral medication clomiphene.
Following that, I was prescribed an ovulation induction plan that involved stimulating the ovaries with follicle stimulating hormone (FSH) injections every other day from day 2-8 to develop an egg. On day 9 the ovaries were monitored with pelvic scans to check the development of the follicles. Once a mature follicle had developed, the stimulating injections were stopped, and an injection of HCG was given to release the eggs 35 hours later.
After over a year of follicular monitoring, ovulation promotion and induction, I was still not pregnant and we were recommended to have in-vitro fertilisation (IVF), especially considering my age (at this stage nearly 38). I had been very fortunate up to this time not to feel any of the common adverse effects associated with the fertility treatments that I had been given, so the concept of IVF was not very daunting to me, but rather quite exciting. I know some other women personally who found each of the steps pre and post IVF very challenging both physically and emotionally, causing them to take time out in between the different stages of the IVF cycles.
Before commencing IVF, I had a saline infusion sonography test which showed the presence of a small endometrial polyp in the wall of the womb. I then underwent a hysteroscopy under general anaesthetic to resection the polyp, as a precaution in case the polyp may interfere with a developing embryo. I then commenced IVF and had one fresh cycle and one frozen embryo transfer cycle, which both failed unfortunately; however, we had a pair of healthy embryos from both cycles, so we were at least pleased with this much success. We then had to get treated privately and decided to have intracytoplasmic sperm injection (ICSI), which involved IVF and additionally the micro injection of my husband’s sperm into my eggs. This was a success the first time around and resulted in the conception and birth of our beautiful children, a boy and a girl.
I was very fortunate that my local medical provider (NHS in the UK) funded all the procedures that I had to overcome my infertility other than the ovarian reserve test. I know other women who suffered from infertility in other countries and found the cost of the fertility treatments inhibitory in themselves and added to their stress.
During the years of privately going through various procedures to help us conceive, we did come across some well-meaning people enquiring as to why we were ‘taking our time’ to have children. This was possibly the most difficult experience to deal with for me. I was fortunate not to find the hormonal treatments too difficult to manage psychologically, and after the first year of trying without success I was accepting that it may not happen to us, as was almost the case for my close relatives. I am aware that everyone experiences success and failure in different ways, and I always still felt fortunate that I had a loving, supportive husband by my side in any case. I wish every woman diagnosed with unexplained fertility every success in their efforts to conceive and accept the outcome whatever that may be.
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Gynoid Fat (Hip Fat and Thigh Fat): Possible Role in Fertility
Gynoid fat accumulates around the hips and thighs, while android fat settles in the abdominal region. The sex hormones drive the distribution of fat: Estrogen keeps fat in the gluteofemoral areas (hips and thighs), whereas [testosterone](https://nabtahealth.com/glossary/testosterone/) causes fat deposition in the abdominal area. Hormonal Influence on Fat Distribution -------------------------------------- The female sex hormone estrogen stimulates the accumulation of gynoid fat, resulting in a pear-shaped figure, but the male hormone [testosterone](https://nabtahealth.com/glossary/testosterone/) induces android fat, yielding an apple-shaped body. Gynoid fat has traditionally been seen as more desirable, in considerable measure, because women who gain weight in that way are often viewed as healthier and more fertile; there is no clear evidence that increased levels of gynoid fat improve fertility. Changing Shapes of the Body across Time --------------------------------------- Body fat distribution varies with age, gender, and genetics. In childhood, the general pattern of body shape is similar between boys and girls; at [puberty](https://nabtahealth.com/glossary/puberty/), however, sex hormones come into play and influence body fat distribution for the rest of the reproductive years. Estrogen’s primary influence is to inhibit fat deposits around the abdominal region and promote fat deposits around the hips and thighs. On the other hand, [testosterone](https://nabtahealth.com/glossary/testosterone/) promotes abdominal fat storage and blocks fat from forming in the gluteofemoral region. In women, disorders like [PCOS](https://nabtahealth.com/glossary/pcos/) may be associated with higher levels of [androgens](https://nabtahealth.com/glossary/androgen/) including [testosterone](https://nabtahealth.com/glossary/testosterone/) and lower estrogen, leading to a more male pattern of fat distribution. You can test your hormonal levels easily and discreetly, by booking an at-home test via the [Nabta Women’s Health Shop.](https://shop.nabtahealth.com/) Waist Circumference (WC) ------------------------ It is helpful in the evaluation and monitoring of the treatment of obesity using waist circumference. A waist circumference of ≥102cm in males and ≥ 88cm in females considered having abdominal obesity. Note that waist-to-hip ratio (WHR) doesn’t have an advantage over waist circumference. After [menopause](https://nabtahealth.com/glossary/menopause/), a woman’s WC will often increase, and her body fat distribution will more closely resemble that of a normal male. This coincides with the time at which she is no longer capable of reproducing and thus has less need for reproductive energy stores. Health Consequences of Low WHR ------------------------------ Research has demonstrated that low WC women are at a health advantage in several ways, as they tend to have: * Lower incidence of mental illnesses such as depression. * Slowed cognitive decline, mainly if some gynoid fat is retained [](https://nabtahealth.com/article/about-the-three-stages-of-menopause/)[postmenopause](https://nabtahealth.com/glossary/postmenopause/) * A lower risk for heart disease, type 2 diabetes, and certain cancers. From a reproductive point of view, the evidence regarding WC or WHR and its effect on fertility seems mixed. 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. Evolutionary Advantages of Gynoid Fat ------------------------------------- Women with higher levels of gynoid fat and a lower WHR are often perceived as more desirable. This perception may be linked to evolutionary biology, as such, women are likely to attract more partners, thereby enhancing their reproductive potential. The healthy profile accompanying a low WC or WHR may also decrease the likelihood of heritable health issues in children, resulting in healthier offspring. Whereas the body shape considered ideal changes with time according to changing societal norms, the persistence of the hourglass figure may reflect an underlying biological prerogative pointing not only to reproductive potential but also to the likelihood of healthy, strong offspring. 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.
Everything you Need to Know About Hypnobirthing
* Jasmine Collin from [Love Parenting UAE](https://www.loveparentinguae.com/), Nabta Health’s hypnotherapy partner, takes us through her guide to all things Hypnobirthing. * Learn how Hypnobirthing supports natural birth, reducing pain and creating an optimal environment during labour. * Nabta’s aim to empower women to reach their health goals as naturally as possible is very much in line with Jasmine’s approach and the benefits of hypnotherapy in labour. * Book Jasmine’s popular online Hypnobirthing course [here.](https://nabtahealth.com/product/the-love-birthing-hypnobirthing-course/) You may have heard of hypnobirthing due to its increasing popularity with expecting parents and [celebrities such as Jessica Alba and Angelina Jolie.](https://www.madeformums.com/pregnancy/celebrity-mums-who-used-hypnotherapy-in-labour/) It’s even been suggested that royal family members, Kate Middleton and Meghan Markle used it to prepare for their births – but what exactly is it and why are so many women turning to Hypnobirthing? **What is Hypnobirthing?** Hypnobirthing is a childbirth preparation method taken as a set of weekly classes either in groups or privately, any time between 20-35 weeks of pregnancy. There are lots of styles of Hypnobirthing available today but they all originate from the Mongan Method, which is over 30 years old. There are also online Hypnobirthing classes available too There are a lot of [misconceptions as to what Hypnobirthing](https://www.loveparentinguae.com/single-post/2019/10/07/why-there-is-no-such-thing-as-a-hypnobirth) is and the type of person who chooses it. Many think it’s just for hippy types wanting a home or [water birth](https://nabtahealth.com/glossary/water-birth/) or those seemingly crazy women who want to do it without pain relief, but the truth is, all women can use it to have a calmer more positive birth experience, no matter what birth they choose or what path it takes. **What is the aim of Hypnobirthing?** One of the aims of Hypnobirthing is to support and increase the likelihood of physiological birth with the least amount of chemicals and interventions wherever possible. However if drugs or medical interventions are truly needed it enables the couple to remain calm and make informed evidence based decisions for themselves and their baby. #### **What are the benefits of natural physiological birth?** Studies have shown us that women and babies who have natural physiological births benefit from better health outcomes, adjustment to life outside the womb, emotional satisfaction with the birth experience and being able to cope well with the transition to motherhood. Read more about [physiological birth](http://www.birthtools.org/What-Is-Physiologic-Birth) and its benefits for families and society as a whole. Hypnobirthing promotes births that mirror nature as closely as possible so that babies and families can get off to the best start possible. #### **What if natural birth is not possible?** Unfortunately, natural physiological birth is not always possible in our current birth culture. There are a large number of influencing factors that we can’t control and birth can be quite unpredictable. So it’s important to acknowledge the wide range of birthing styles, combinations of drugs, interventions and different experiences that can happen, so we can fully prepare couples for all eventualities. The great news is that the knowledge and techniques learnt in Hypnobirthing classes are applicable in all situations and in all types of birth. In fact the tools can be even more useful in assisted births like C- sections, epidurals and inductions etc. because they keep the mother and baby calm during potentially more stressful events. #### **Real Hypnobirthing stories** Here are a few birth stories from parents who had all types of birthing experiences and how Hypnobirthing helped them through. [The induction for](https://babyandchild.ae/uae-birth-guide/article/1523/labour-was-more-powerful-and-beautiful-than-i-could-have-imagined) [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) one [The induction and low](https://www.jasminecollin.com/single-post/2019/05/06/Taylors-Birth---A-calm-positive-tale-of-thrombocytopenia-induction-low-fluid-and-more) [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/) one [The planned gentle C-section one](https://www.jasminecollin.com/single-post/2017/04/16/Hanis-Birth---A-Family-Centred-Cesarean) [The one with no progress](https://www.jasminecollin.com/single-post/2017/05/04/Charleys-Birth) [The big baby one](https://babyandchild.ae/uae-birth-guide/birth-stories/article/1372/how-hypnobirthing-helped-me-give-birth-to-my-5kg-baby-drug-free) [The unplanned C-section one](https://www.jasminecollin.com/single-post/2015/05/10/10-Healthy-Foods-That-Calm-DeStress) [The VBA2C (Vaginal Birth after 2 C sections) one](https://www.jasminecollin.com/single-post/2017/04/23/Marsels-Birth---A-VBA2C-Story) [The planned vaginal](https://www.jasminecollin.com/single-post/2017/08/13/Phoenix-Willows-Breech-Birth) [breech](https://nabtahealth.com/glossary/breech/) one [The unplanned vaginal](https://www.jasminecollin.com/single-post/2017/01/26/Georges-Breech-Birth) [breech](https://nabtahealth.com/glossary/breech/) one As you can read in the birth stories, Hypnobirthing can benefit mothers and babies in all situations – but it’s not just them that benefit. Let’s not forget the partners. These days’ partners are not just welcome in the delivery room; they are expected to support the mother during labour and birth. However, without adequate training this can throw them into an environment and situation that they are not adequately prepared for. In Hypnobirthing classes partners gain invaluable knowledge and skills that they can apply in the birthing room to ensure a positive birth experience for the mother, baby and themselves. And the benefits don’t just stop in the birthing room. Lots of couples continue to use the tools for relaxing the mind and body long after the birth is over. Read- [7 surprising reasons to do Hypnobirthing that have nothing to do with birth](http://www.loveparentinguae.com/single-post/2017/08/02/7-Surprising-Reasons-To-Do-Hypnobirthing-Classes-That-Have-Nothing-To-Do-With-Birth) #### **So how does Hypnobirthing work exactly?** **During pregnancy** It empowers couples with the knowledge and belief that women’s bodies are designed to grow and birth their babies and that childbirth is a natural physiological process. It promotes healthy nutrition and physical exercise in pregnancy as being key factors in having a safe and easier birth as well sharing top tips on how to get the baby into the optimal position for birthing. Like any big physical event such as running a marathon or climbing a mountain, it’s not just physical preparation that makes the difference. Yes, physical fitness plays a big part, but a positive mindset and being emotional fit is just as important, and this is where Hypnobirthing comes in. Hypnobirthing de-hypnotises couples from all the negative information and fear that they’ve been conditioned with all their lives and updates their mindset through guided visualisations, affirmations and fear release work, all while they are very deeply relaxed or ‘in hypnosis’. Being in a natural state of hypnosis, promotes deep relaxation and being open to suggestion, so during pregnancy we can give the mind set an upgrade by accessing the sub conscious mind and reprograming it with more positive beliefs, thoughts and feelings about birth. When pregnant woman are calm and feel fully supported, their babies, who are literally swimming in their emotions, also feel the benefits. During classes there is also a focus on pre birth family bonding and this helps couples to adjust to their new roles and embrace early parenthood more easily. #### **Hypnobirthing during labour & birth** When a woman goes into labour with less fear and more understanding of how her body works and what it’s doing at each stage she can accept it more easily and experience it in a more positive way. When she relaxes and welcomes the sensations, rather than fighting them, they can then become easier to manage. Practically speaking Hypnobirthing teaches couples how to maximize the normal physiological birth process by creating the optimal environment for birth. Humans are biologically programmed in the same way that all mammals are and our birth environment needs are very similar. All mammals birth more easily in safe, warm, dark, private, quiet and undisturbed settings where there is no rush and no feeling of being watched or observed. In this ideal setting the perfect and natural combination of birthing hormones can be released and labour can progress. If however there is any sense of a potential threat or disturbance, our fight or flight response can release hormones that will slow or even stop labour. Even a bright light or a cold room is enough to slow down labour. It’s not always possible to control the external environment though, for example when driving to the hospital or in a typical hospital room, where it’s normally bright, busy and rushed, with lots of observation, disturbances and possible fear triggers. Hypnobirthing skills are crucial in these less than optimal settings because they enable the mother to create a calm and resourceful internal mental state. Using her practiced breathing, visualisations, affirmations and hypnosis she can bring her body and mind into a deep state of relaxation as if she were in the ideal environment. The body cannot tell the difference between real and imagined, so she can use this mind-body hack to convince her body that it’s a safe space and a good time to be birthing her baby. The body then continues releasing the perfect cocktail of hormones for a quicker, easier and more natural birth. #### But what about the pain? A birthing mother automatically reduces pain by being calmer and less frightened of the birth, and in calm, safe settings the birthing body naturally produces [endorphins](https://nabtahealth.com/glossary/endorphins/), our own natural pain relief, to help us cope with the intense physical sensations. In addition, Hypnobirthing mums can use hypnosis to disrupt and change the way that their brain processes pain signals. They also learn mental coping strategies and physical comfort tools to deal with any discomfort that they feel. All these factors make it less likely that they will need pain relieving drugs or unnecessary interventions and they tend to have more straightforward and quicker labours. Of course if a woman is struggling then there is a selection of pain relieving drugs that the hospital can offer. The aim of Hypnobirthing however is to ensure the couple have a complete toolbox of skills and techniques that they can utilize before getting to that point, so that it can be delayed or avoided all together. But, no matter how a baby is born or whatever interventions or drugs are used, the most important elements for every birthing mother are that: * She feels calm, safe, and supported throughout. * She feels that she did her best and gave it all she had. * She feels treated with dignity and respect. * And she was able to make her own informed choices about her baby, body and birth, every step of the way. These are the key ingredients to a positive birth experience and what Hypnobirthing is all about. Surely every mother and her family deserves this birth experience…not just the hippies. \_\_\_\_\_ Jasmine Collin is a mother of two, a qualified Hypnotherapist, NLP Practitioner, Childbirth Educator and Doula who specialises in Hypnobirthing and Parenting Originally from the UK she is the longest running teacher in the UAE and has been teaching her award winning ‘Love Birthing’ classes since 2009. She is the co founder of Love Parenting UAE, winner of the 2018 Time Out Kids Award for ‘Special recognition for pre and post natal care’ and is dedicated to helping couples have calmer, more positive births so that they can ‘Love Birthing’ no matter what kind of birth they choose or what path birth takes. For more information contact: [\[email protected\]](/cdn-cgi/l/email-protection) You can book Jasmine’s popular online Hypnobirthing services on the [Nabta Women’s Health Shop.](https://nabtahealth.com/product/the-love-birthing-hypnobirthing-course/) \_\_\_ 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 [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#acd5cdc0c0cdecc2cdced8cdc4c9cdc0d8c482cfc3c1) if you have any questions about this article or any aspect of women’s health. We’re here for you.
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.