A new possibility in fertility preservation: The artificial ovary

Abstract

Conventional fertility preservation methods such as oocyte or embryo cryopreservation are currently insufficient to treat including those patients with prepubertal cancer and premature ovarian failure. Ovarian tissue cryopreservation presents as an alternative but has limitations with a potential risk of reintroducing malignant cells in patients who recover from cancer, those of chemotherapy prior to tissue cryopreservation. The so called “artificial ovary” aims to resolve this issue by transplanting isolated follicles with or without a biological scaffold. The artificial ovary may also offer an effective alternative option for those who cannot benefit from traditional assisted reproductive techniques such as in vitro fertilisation. To date, in animal studies and human trial, the artificial ovary restored endocrine function, achieved in vivo follicular development, and resulted in successful pregnancies. However, development of a technique for higher follicular recovery rate and a more optimised design of delivery scaffold, better transplantation techniques to prevent postsurgical ischemia, and consideration for genetic safety are required for safer and consistent human clinical applications. Ideas from different transplantation surgeries (e.g., entire ovary, ovarian cortex, and transplantation with tissue‐engineered products) can be applied to enhance the efficacy of artificial ovarian transplantation. For the better application of artificial ovary, a deeper understanding of mechanical and biochemical properties of the ovary and folliculogenesis after cryopreservation, transplantation with or without scaffold, and development of sophisticated in vivo imaging techniques of transplanted artificial ovary need to precede its efficient clinical application.

Bioethical and Legal Issues in 3D Bioprinting

“…in humans. Research is underway in the field of reproductive medicine using bioprinting technologies, in particular, the biofabrication of artificial ovaries[ 15 - 18 ].…”

Current and Future Perspectives for Improving Ovarian Tissue Cryopreservation and Transplantation Outcomes for Cancer Patients

“…In addition, the technique may be used to develop follicles under in vitro conditions, thereby avoiding tumor contamination or placing these isolated follicles in the transplantation area with the assistance of scaffolds. An artificial ovary can be used to mature oocytes through a multistep process, including sequential in vitro culturing of oocytes, isolated follicles, and OT [136][137][138][139][140][141][142][143][144][145]. Multiple studies have shown that the live birth rate using this option is comparable to that of conventional IVF [146,147].…”

“…To date, animal studies have demonstrated that this approach restores endocrine function, also enabling in vivo follicular development and successful pregnancy; however, no successful human trials have been reported [138][139][140]142]. Developing techniques through which to increase follicular recovery rate and optimize scaffold design, as well as transplantation techniques to prevent postoperative ischemia, and genetic safety considerations, are all necessary for safer and more consistent human clinical applications [136].…”

Untitled

“…There is an accumulating evidence of utility success of ovarian auto graft to prevent or postpone the premature ovarian failure [28]. The implanted ovarian tissue called artificial ovary could restore the endocrine function and the ability to get successful pregnancy [29].…”