Indiana University-Purdue University Indianapolis (IUPUI) / Cancer treatment-related fatigue (CTRF) is recognized as a prevalent and bothersome symptom for patients with cancer. In a model of the CTRF experience, CTRF representation, or the beliefs, thoughts and emotions surrounding the experience of CTRF, is believed to mediate the relationship between CTRF intensity and CTRF distress. To date, there is no reported measure of CTRF representation. The purpose of this descriptive, cross-sectional study guided by Leventhal’s Common Sense Model of Self-Regulation was to evaluate an instrument designed to measure CTRF representation, the CTRF Representation scale (CTRFRep), based on an existing measure, the Illness Perception Questionnaire (IPQ-R). The study included 47 patients (mean age=57.7 years) receiving radiation therapy for cancer interviewed one month post-treatment. 77% of patients had fatigue during treatment. Three content experts and one theory expert assessed content validity of the CTRFRep. The content experts included three behavioral oncology nurse researchers whose focus is on symptom management and/or fatigue. The theory expert was a nurse researcher who is an expert in the area of self-regulation theory. As tested, the CTRFRep consisted of 105 items in 10 subscales addressing beliefs about the Identity, Timeline (Acute vs. Chronic/Cyclical), Consequences (positive/negative), Cause, Control (Treatment/Personal), Symptom Coherence, and Emotional Representation of CTRF. When evaluating psychometrics, the Identity and Cause subscales are analyzed independent of the other subscales. For the Identity subscale, symptoms most reported as related to CTRF were lack of energy, loss of strength, and feeling blue. For the Cause subscale, the most common beliefs regarding causes of CTRF were cancer treatment(s), having cancer, and stress or worry. Results indicate adequate reliability in six of eight remaining subscales (α>=0.70); the item N in those subscales was reduced from 56 to 34. To address construct validity, logistic regression assessed whether CTRFRep mediated the relationship between CTRF intensity and CTRF distress. After controlling for negative affect, the Identity and Consequences subscales were significant mediators – the Acute vs. Chronic Timeline and Emotional Representation scales were partial mediators – of the relationship between CTRF intensity on CTRF distress. These findings indicate fatigue is a problem for people undergoing treatment for cancer, and the CTRFRep may be a reliable and valid measure of CTRF representation for patients undergoing radiation treatment for cancer. Small sample size prevented successful factor analysis of the CTRFRep. Further research of the CTRFRep is warranted.

Partners play a critical role in making decisions about fertility preservation among young patients with cancer, yet little is known about these dyadic decisions when planning cancer treatment. Fertility preservation entails helping cancer patients preserve fertility after cancer treatment. This qualitative study investigated: 1) Heterosexual couples' responses to potential fertility loss; 2) their process in making fertility preservation decisions; 3) their ethical and legal concerns, and 4) recommendations for other couples undergoing similar treatment. Semi-structured interviews were conducted with 12 heterosexual couples whose female partners were diagnosed with cancer and had received fertility preservation consultations within the past 5 years. Interviews were recorded, transcribed, and analyzed using grounded theory methods. The results indicated that couples have varied reactions to infertility. In most, spouses let the patients take the lead in, and supported, their fertility preservation decisions. Spouses recommended support to patients. Couples face challenges in making fertility preservation decisions. Input from, and support for, both partners is essential to ensure well-informed, high-quality fertility preservation decisions.

Mucositis manifesting as diarrhoea is a common side effect of chemotherapy which remains poorly understood. It is one of a number of manifestations of alimentary mucositis, which affects the entire gastrointestinal tract. The exact number of patients that are affected by diarrhoea as a result of treatment is uncertain, although it is believed that approximately 10% of patients with advanced cancer will be afflicted. Despite advances in the understanding of oral and small intestinal mucositis over recent years, large intestinal mucositis, including diarrhoea, has not been well defined and the underlying mechanisms of the condition are yet to be established. The majority of the literature available concerning diarrhoea is based on clinical observations, with very little basic research existing. However, from the research conducted, it is likely that the intestinal microflora and mucins play a role in the development of chemotherapy-induced diarrhoea. This thesis will examine in detail what is known about the mechanisms of chemotherapy-induced diarrhoea (CID). Furthermore it will explore the potentially important relationship between intestinal microflora, the luminal environment and the subsequent development of chemotherapy-induced mucositis and diarrhoea. 5-Fluorouracil (5-FU) is a commonly used chemotherapy agent in clinical oncology practice. Two of its major side effects are mucositis and diarrhoea. The structure of mucins offers mucosal protection, and allows maintenance of intestinal flora by providing attachment sites and preventing bacterial overgrowth and/or penetration. Following treatment with 5-FU, we showed decreases in Clostridium spp., Lactobacillus spp. and Streptococcus spp., and an increase in Escherichia spp. in the jejunum. In the colon, 5-FU caused decreases in Enterococcus spp., Lactobacillus spp. and Streptococcus spp. Real time PCR of faecal samples showed decreasing trends in Lactobacillus spp. and Bacteroides spp., and an increasing trend in E. coli. Significant increases (p<0.05) were seen in Clostridium spp. and Staphylococcus spp. at 24 h. Goblet cell numbers decreased significantly in the jejunum from 24-72 h, with a significant increase in the percentage of cavitated goblet cells, suggesting 5-FU treatment causes significant changes in intestinal flora and mucin secretion in rats. These changes could result in systemic effects, and in particular may contribute to the development of chemotherapy-induced mucositis. Irinotecan causes cholinergic and delayed onset diarrhoea in patients, in which β-glucuronidase produced by gut bacteria is thought to be involved. Diarrhoea was observed in treated rats, as expected, following irinotecan treatment. β-glucuronidase expression increased in the jejunum and colon. Faecal flora changed quantitatively after treatment also, with increases in E. coli, Staphylococcus spp., and Clostridium spp. (all β-glucuronidase producing), and decreases in Lactobacillus spp., Bifidobacterium spp. (both beneficial bacteria), and Bacteroides spp. (β-glucuronidase producing, major component of intestinal flora), suggesting that irinotecan-induced diarrhoea may be caused by an increase in β-glucuronidase producing bacteria. However, the increase in bacteria may also be caused by irinotecan, further exaggerating the toxicity of the drug, and emphasising the need for these specific bacteria to be therapeutically targeted for successful treatment regimens to be accomplished. Mucus production appears to be increased after irinotecan treatment, which may contribute to the development of diarrhoea. Goblet cells were demonstrated to decrease significantly after irinotecan treatment. However, mucin secretion increased. Mucin expression changed significantly after treatment. Muc2 and Muc4 decreased significantly in the villi of the jejunum after treatment, Muc2 and Muc4 decreased significantly in the crypts. Muc2 decreased significantly in the colon. This indicates that irinotecan causes an increase in mucin secretion and a net decrease in mucin-producing goblet cells, and the expression of Muc2 and Muc4 in the gastrointestinal tract is altered following treatment. Increased mucin secretion is likely to be related to altered mucin expression, and may contribute to chemotherapy-induced diarrhoea. To determine if the changes to the intestinal microflora caused by chemotherapy could be translated to the clinic, a pilot clinical study was carried out. Sixteen patients experiencing CID were recruited to the study with two control subjects. A large proportion of patients (75%) demonstrated a reduced anaerobic component of their faecal microflora. A reduced diversity of species was also observed in patients. The majority of patients exhibited decreases in Clostridium spp., Lactobacillus spp. and Bifidobacterium spp., whilst all patients exhibited decreases in Bacteroides spp. and Enterococcus spp. Patients receiving antibiotics did not exhibit any marked differences to patients not receiving antibiotics. This indicates that the results observed in the animal studies are clinically relevant, and further research into this area should be undertaken. CID is associated with marked changes in the intestinal microflora. These changes may result in diminished bacterial functions within the gut, altering gut function and initiating intestinal damage, resulting in the onset of diarrhoea. In conclusion, there is clear evidence demonstrating chemotherapy treatment results in changes to the intestinal microflora and mucin secretion, which may be responsible in part for the development of severe mucositis and diarrhoea. Irinotecan toxicity may be compounded by the increase in β-glucuronidase producing bacteria. The intestinal flora of cancer patients experiencing CID is also noticeably different to that of healthy subjects. Irinotecan causes changes to mucin secretion, and the specific expression of Muc2, Muc4 and Klf4, suggesting that secretory control by the enteric nervous system may also be affected by chemotherapy. This research has extended the understanding of chemotherapy-induced mucositis and diarrhoea, complex side effects of chemotherapy. However, new areas for future research have also been identified. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352119 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

Mucositis manifesting as diarrhoea is a common side effect of chemotherapy which remains poorly understood. It is one of a number of manifestations of alimentary mucositis, which affects the entire gastrointestinal tract. The exact number of patients that are affected by diarrhoea as a result of treatment is uncertain, although it is believed that approximately 10% of patients with advanced cancer will be afflicted. Despite advances in the understanding of oral and small intestinal mucositis over recent years, large intestinal mucositis, including diarrhoea, has not been well defined and the underlying mechanisms of the condition are yet to be established. The majority of the literature available concerning diarrhoea is based on clinical observations, with very little basic research existing. However, from the research conducted, it is likely that the intestinal microflora and mucins play a role in the development of chemotherapy-induced diarrhoea. This thesis will examine in detail what is known about the mechanisms of chemotherapy-induced diarrhoea (CID). Furthermore it will explore the potentially important relationship between intestinal microflora, the luminal environment and the subsequent development of chemotherapy-induced mucositis and diarrhoea. 5-Fluorouracil (5-FU) is a commonly used chemotherapy agent in clinical oncology practice. Two of its major side effects are mucositis and diarrhoea. The structure of mucins offers mucosal protection, and allows maintenance of intestinal flora by providing attachment sites and preventing bacterial overgrowth and/or penetration. Following treatment with 5-FU, we showed decreases in Clostridium spp., Lactobacillus spp. and Streptococcus spp., and an increase in Escherichia spp. in the jejunum. In the colon, 5-FU caused decreases in Enterococcus spp., Lactobacillus spp. and Streptococcus spp. Real time PCR of faecal samples showed decreasing trends in Lactobacillus spp. and Bacteroides spp., and an increasing trend in E. coli. Significant increases (p<0.05) were seen in Clostridium spp. and Staphylococcus spp. at 24 h. Goblet cell numbers decreased significantly in the jejunum from 24-72 h, with a significant increase in the percentage of cavitated goblet cells, suggesting 5-FU treatment causes significant changes in intestinal flora and mucin secretion in rats. These changes could result in systemic effects, and in particular may contribute to the development of chemotherapy-induced mucositis. Irinotecan causes cholinergic and delayed onset diarrhoea in patients, in which β-glucuronidase produced by gut bacteria is thought to be involved. Diarrhoea was observed in treated rats, as expected, following irinotecan treatment. β-glucuronidase expression increased in the jejunum and colon. Faecal flora changed quantitatively after treatment also, with increases in E. coli, Staphylococcus spp., and Clostridium spp. (all β-glucuronidase producing), and decreases in Lactobacillus spp., Bifidobacterium spp. (both beneficial bacteria), and Bacteroides spp. (β-glucuronidase producing, major component of intestinal flora), suggesting that irinotecan-induced diarrhoea may be caused by an increase in β-glucuronidase producing bacteria. However, the increase in bacteria may also be caused by irinotecan, further exaggerating the toxicity of the drug, and emphasising the need for these specific bacteria to be therapeutically targeted for successful treatment regimens to be accomplished. Mucus production appears to be increased after irinotecan treatment, which may contribute to the development of diarrhoea. Goblet cells were demonstrated to decrease significantly after irinotecan treatment. However, mucin secretion increased. Mucin expression changed significantly after treatment. Muc2 and Muc4 decreased significantly in the villi of the jejunum after treatment, Muc2 and Muc4 decreased significantly in the crypts. Muc2 decreased significantly in the colon. This indicates that irinotecan causes an increase in mucin secretion and a net decrease in mucin-producing goblet cells, and the expression of Muc2 and Muc4 in the gastrointestinal tract is altered following treatment. Increased mucin secretion is likely to be related to altered mucin expression, and may contribute to chemotherapy-induced diarrhoea. To determine if the changes to the intestinal microflora caused by chemotherapy could be translated to the clinic, a pilot clinical study was carried out. Sixteen patients experiencing CID were recruited to the study with two control subjects. A large proportion of patients (75%) demonstrated a reduced anaerobic component of their faecal microflora. A reduced diversity of species was also observed in patients. The majority of patients exhibited decreases in Clostridium spp., Lactobacillus spp. and Bifidobacterium spp., whilst all patients exhibited decreases in Bacteroides spp. and Enterococcus spp. Patients receiving antibiotics did not exhibit any marked differences to patients not receiving antibiotics. This indicates that the results observed in the animal studies are clinically relevant, and further research into this area should be undertaken. CID is associated with marked changes in the intestinal microflora. These changes may result in diminished bacterial functions within the gut, altering gut function and initiating intestinal damage, resulting in the onset of diarrhoea. In conclusion, there is clear evidence demonstrating chemotherapy treatment results in changes to the intestinal microflora and mucin secretion, which may be responsible in part for the development of severe mucositis and diarrhoea. Irinotecan toxicity may be compounded by the increase in β-glucuronidase producing bacteria. The intestinal flora of cancer patients experiencing CID is also noticeably different to that of healthy subjects. Irinotecan causes changes to mucin secretion, and the specific expression of Muc2, Muc4 and Klf4, suggesting that secretory control by the enteric nervous system may also be affected by chemotherapy. This research has extended the understanding of chemotherapy-induced mucositis and diarrhoea, complex side effects of chemotherapy. However, new areas for future research have also been identified. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352119 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

Mucositis manifesting as diarrhoea is a common side effect of chemotherapy which remains poorly understood. It is one of a number of manifestations of alimentary mucositis, which affects the entire gastrointestinal tract. The exact number of patients that are affected by diarrhoea as a result of treatment is uncertain, although it is believed that approximately 10% of patients with advanced cancer will be afflicted. Despite advances in the understanding of oral and small intestinal mucositis over recent years, large intestinal mucositis, including diarrhoea, has not been well defined and the underlying mechanisms of the condition are yet to be established. The majority of the literature available concerning diarrhoea is based on clinical observations, with very little basic research existing. However, from the research conducted, it is likely that the intestinal microflora and mucins play a role in the development of chemotherapy-induced diarrhoea. This thesis will examine in detail what is known about the mechanisms of chemotherapy-induced diarrhoea (CID). Furthermore it will explore the potentially important relationship between intestinal microflora, the luminal environment and the subsequent development of chemotherapy-induced mucositis and diarrhoea. 5-Fluorouracil (5-FU) is a commonly used chemotherapy agent in clinical oncology practice. Two of its major side effects are mucositis and diarrhoea. The structure of mucins offers mucosal protection, and allows maintenance of intestinal flora by providing attachment sites and preventing bacterial overgrowth and/or penetration. Following treatment with 5-FU, we showed decreases in Clostridium spp., Lactobacillus spp. and Streptococcus spp., and an increase in Escherichia spp. in the jejunum. In the colon, 5-FU caused decreases in Enterococcus spp., Lactobacillus spp. and Streptococcus spp. Real time PCR of faecal samples showed decreasing trends in Lactobacillus spp. and Bacteroides spp., and an increasing trend in E. coli. Significant increases (p<0.05) were seen in Clostridium spp. and Staphylococcus spp. at 24 h. Goblet cell numbers decreased significantly in the jejunum from 24-72 h, with a significant increase in the percentage of cavitated goblet cells, suggesting 5-FU treatment causes significant changes in intestinal flora and mucin secretion in rats. These changes could result in systemic effects, and in particular may contribute to the development of chemotherapy-induced mucositis. Irinotecan causes cholinergic and delayed onset diarrhoea in patients, in which β-glucuronidase produced by gut bacteria is thought to be involved. Diarrhoea was observed in treated rats, as expected, following irinotecan treatment. β-glucuronidase expression increased in the jejunum and colon. Faecal flora changed quantitatively after treatment also, with increases in E. coli, Staphylococcus spp., and Clostridium spp. (all β-glucuronidase producing), and decreases in Lactobacillus spp., Bifidobacterium spp. (both beneficial bacteria), and Bacteroides spp. (β-glucuronidase producing, major component of intestinal flora), suggesting that irinotecan-induced diarrhoea may be caused by an increase in β-glucuronidase producing bacteria. However, the increase in bacteria may also be caused by irinotecan, further exaggerating the toxicity of the drug, and emphasising the need for these specific bacteria to be therapeutically targeted for successful treatment regimens to be accomplished. Mucus production appears to be increased after irinotecan treatment, which may contribute to the development of diarrhoea. Goblet cells were demonstrated to decrease significantly after irinotecan treatment. However, mucin secretion increased. Mucin expression changed significantly after treatment. Muc2 and Muc4 decreased significantly in the villi of the jejunum after treatment, Muc2 and Muc4 decreased significantly in the crypts. Muc2 decreased significantly in the colon. This indicates that irinotecan causes an increase in mucin secretion and a net decrease in mucin-producing goblet cells, and the expression of Muc2 and Muc4 in the gastrointestinal tract is altered following treatment. Increased mucin secretion is likely to be related to altered mucin expression, and may contribute to chemotherapy-induced diarrhoea. To determine if the changes to the intestinal microflora caused by chemotherapy could be translated to the clinic, a pilot clinical study was carried out. Sixteen patients experiencing CID were recruited to the study with two control subjects. A large proportion of patients (75%) demonstrated a reduced anaerobic component of their faecal microflora. A reduced diversity of species was also observed in patients. The majority of patients exhibited decreases in Clostridium spp., Lactobacillus spp. and Bifidobacterium spp., whilst all patients exhibited decreases in Bacteroides spp. and Enterococcus spp. Patients receiving antibiotics did not exhibit any marked differences to patients not receiving antibiotics. This indicates that the results observed in the animal studies are clinically relevant, and further research into this area should be undertaken. CID is associated with marked changes in the intestinal microflora. These changes may result in diminished bacterial functions within the gut, altering gut function and initiating intestinal damage, resulting in the onset of diarrhoea. In conclusion, there is clear evidence demonstrating chemotherapy treatment results in changes to the intestinal microflora and mucin secretion, which may be responsible in part for the development of severe mucositis and diarrhoea. Irinotecan toxicity may be compounded by the increase in β-glucuronidase producing bacteria. The intestinal flora of cancer patients experiencing CID is also noticeably different to that of healthy subjects. Irinotecan causes changes to mucin secretion, and the specific expression of Muc2, Muc4 and Klf4, suggesting that secretory control by the enteric nervous system may also be affected by chemotherapy. This research has extended the understanding of chemotherapy-induced mucositis and diarrhoea, complex side effects of chemotherapy. However, new areas for future research have also been identified. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352119 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

The main aim of this dissertation is to discuss the way women negotiate the cultural meaning of hair loss, alopecia, as a result of undergoing chemotherapy, and to understand, accordingly, how cancer's cultural effects regarding women can be deeply different from those of men. Very few studies have been done about the cultural impact and resonance of alopecia. It is often regarded as "secondary" to other effects of chemotherapy. Because, in many cultures, head hair for women expresses or manifests attractiveness and power, to be bald is to be deprived of the ability to fit into society, whether in the public or private sphere. The study examines the representation of such women in the media, audience/subject responses to these representations, and interrogates women's identities and representations in terms of Laura Mulvey's theory of the male gaze. Women who have experienced chemotherapy-induced alopec ia were interviewed in this regard. Other contributive feminist, cultural and/or media studies works, such as those by Suzanna Walters, Susan Bordo, Naomi Wolf, Donna Haraway, Stuart Hall, Kimberle Crenshaw, and Judith Butler, help facilitate the analysis. From these perspectives, a historical analysis takes into consideration the symbolic dimension of hair, especially women's head hair, within Western cultural history, particularly in France and a multicultural America. In addition, a textual analysis looks at women, cancer, and hair loss as represented in popular culture characters and personalities. The study insists on the necessity for women to resist to the culture industries and deconstruct the male gaze, as well as the female gaze, which can both contribute to, and perpetuate women's objectification. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

[Truncated abstract] Therapeutic Radiation has been used for the treatment of cancer and other diseases for nearly a century. Over the past 20 years, Hyperbaric Oxygen Treatment (HBOT) has been used to assist wound healing in the prevention and treatment of the more severe complications associated with the side effects of Therapeutic Radiation Treatment (TRT). The use of HBOT is based on the premise that increased oxygen tissue tension aids wound healing by increasing the hypoxic gradient and stimulating angiogenesis and fibroblast differentiation. As it takes up to 6 months for a hypoxic state to develop in treated tissue, following radiation treatment, current recommendations for HBOT state that it is not effective until after this time. During this 6 month period, immediately following TRT, many specialized tissues in or adjacent to the field of irradiation, such as salivary glands and bone, are damaged due to a progressive thickening of arteries and fibrosis, and these tissues are never replaced. Currently, HBOT is used to treat the complications of TRT, but it would be far better if they could be prevented . . . In summary, this experimental model has fulfilled its prime objective of demonstrating that HBOT is effective in reducing the long-term side effects of therapeutic radiation treatment in normal tissue, when given one week after the completion of the radiation treatment and statistically disproves the Null Hypothesis that there is no difference in the incidence of postoperative complications or morbidity of TRT when 20 intermittent daily HBOT are started one week after completion of TRT. This project provides an extensive description of the histological process and also proposes a hypothesis for the molecular events that may be taking place.

Thesis (MScMedSc (Obstetrics and Gynaecology))--Stellenbosch University, 2008. / BACKGROUND: The cryopreservation and transplantation of ovarian tissue have been shown to restore ovarian function temporarily and may also preserve the fertility of young female cancer patients until after their sterilizing cancer treatment. Since tissue samples are large and morphologically complex, the cryopreservation methodology is difficult to optimize and standardise. Ovarian tissue cryopreservation is therefore, still in its experimental stages and is not a routine option offered to cancer patients. OBJECTIVES: Our main aim was to initiate, develop and implement a practical ovarian tissue cryopreservation and re-transplantation protocol which would restore ovarian function, and possibly fertility, in young female cancer patients undergoing sterilizing cancer therapies in South Africa. The objective of this study was to improve the slow cryopreservation protocol for human ovarian tissue. The ultrastructural effects after cryopreservation with two well-known cryoprotectants, dimethyl sulfoxide (DMSO) and 1,2-propylene glycol (PROH), on early human follicles were investigated and compared to identify and the better cryoprotectant. MATERIALS AND METHODS: A single group experimental study design was used. The participants consisted cancer patients of the Gynaecological Oncology Unit of Tygerberg Hospital who entered on a basis of voluntary informed consent. Ovarian tissue was obtained by laparoscopic oophorectomy. After dissection of the ovary(ies), some fresh cortical tissue was sent for metastatic analysis and a few strips taken as fresh control. Remaining dissected ovarian cortical tissue sections of each patient were equally divided into the two cryoprotectant groups. Five resulting groups could be compared: i) fresh tissue (control group); tissue equilibrated in ii) DMSO; or iii) PROH and tissue equilibrated and cryopreserved in iv) DMSO or v) PROH. Five tissue samples per patient were therefore fixed for standard histological haematoxylin and eosin (HE) staining and transmission electron microscopy (TEM). Tissue samples showing early follicles on HE slides were sent for TEM processing. Ultrastructural studies on micrographs of primordial and primary follicles were assessed according to a scoring system which gave an indication of follicular health. Appropriate statistical tests were applied to analyse the mean scores where P≤0.05 was considered as statistically significant. RESULTS: No significant overall cryopreservation treatment effect was evident in any of the follicular ultrastructures evaluated. This result indicated that the cryopreservation protocol used did not induce significant damage to the cortex tissue compared to the fresh control group. Comparison of the effect of PROH and DMSO on the follicular ultrastructures showed that PROH tend to induce more extensive damage, especially after cryopreservation. Correlation studies showed significant positive relationships between the majority of the evaluated ultrastructures, especially between the oocyte and granulosa cell layer and basal membrane. The stromal cells and extracellular matrix did not correlate well with other structures. Correlations indicated that the granulosa cells, oocyte and basal lamina are affected similarly and that the damage in one of these structures may be representative of the damage in the other structures. CONCLUSION: The main aim of the study was achieved since results showed that no significant damage was induced by the cryopreservation protocols. Ovarian tissue cryopreserved in this study has shown to restore endocrine function temporarily after heterotopic autotransplantation in menopausal patients. From the electron microscopy evaluations, DMSO showed better cryopreservation results. The DMSO cryopreservation protocol was also more time efficient and has shown the most successful outcomes in the literature. The stromal tissue seemed to be affected differently by cryopreservation compared to the primordial follicle ultrastructures. Younger patients are needed for future studies since a larger initial follicular reserve may allow for larger follicle sample sizes.