Cryopreservation of Ovarian Tissue: Opportunities Beyond Fertility Preservation and a Positive View Into the Future

Abstract

In current years, ovarian tissue cryopreservation (OTC) and transplantation is gaining ground as a successful method of preserving fertility in young women with primarily cancer diseases, hereby giving them a chance of becoming biological mothers later on. However, OTC preserves more than just the reproductive potential; it restores the ovarian endocrine function and thus the entire female reproductive cycle with natural levels of essential hormones. In a female population with an increased prevalence in the loss of ovarian function due to induced primary ovarian insufficiency (POI) and aging, there is now, a need to develop new treatments and provide new opportunities to utilize the enormous surplus of follicles that most females are born with and overcome major health issues associated with the lack of ovarian hormones. Cell/tissue-based hormone replacement therapy (cHRT) by the use of stored ovarian tissue could be one such option comprising both induction of puberty in prepubertal POI girls, treatment of POI and premature menopause, and as primary prevention at the onset of menopause. In the current review, we explore known and entirely new applications for the potential utilization of OTC including cHRT, social freezing, culture of immature oocytes, and a modern ovarian resection for women with polycystic ovaries, and discuss the indications hereof.

A prospective study of women and girls undergoing fertility preservation due to oncologic and non‐oncologic indications in Sweden–Trends in patients’ choices and benefit of the chosen methods after long‐term follow up

“…Today, CoOT is considered to have a potential to evolve into a standard therapy in the near future . In Denmark, CoOT has been considered a clinical treatment from its inception . Although a potentially much higher number of oocytes could be cryopreserved by ovarian tissue freezing than when performing COS for CoO, optimization of transplantation techniques is needed to improve survival of follicles in the transplant .…”

“…1 In Denmark, CoOT has been considered a clinical treatment from its inception. 24 Although a potentially much higher number of oocytes could be cryopreserved by ovarian tissue freezing than when performing COS for CoO, optimization of transplantation techniques is needed to improve survival of follicles in the transplant. 25 Even though advances in surgical technique aimed to avoid initial ischemia after transplantation have been recently reported, [26][27][28] limitations of the method include the need of surgery for re-transplantation and, most importantly, the preclusion of future re-transplantation of the tissue in women with malignancy that may involve the ovary, due to the risk of reintroduction of malignant cells.…”

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

“…With OTC the concerns of the patients are met at multiple levels: by allowing a short interval between diagnosis and initiation of cancer treatment, having no concern about aggravating a hormone‐sensitive cancer, and providing restoration of fertility with the chance of multiple conceptions—the natural way—and revival of circulating hormones. The latter can provide natural endogenous hormone therapy for puberty induction in childhood cancer survivors and for women who enter menopause prematurely . In addition, the collection and in vitro maturation of immature oocytes in connection with OTC provides an additional fertility potential, which could be essential especially for patients with cancers originating in the ovary .…”

“…The latter can provide natural endogenous hormone therapy for puberty induction in childhood cancer survivors and for women who enter menopause prematurely. [27][28][29] In addition, the collection and in vitro maturation of immature oocytes in connection with OTC provides an additional fertility potential, which could be essential especially for patients with cancers originating in the ovary. 29 Irrespective of all the above, it should always be prioritized to treat patients as quickly and safely as possible, and in our view OTC in most instances qualifies to be the preferred option for FP, which is in accordance with the current recommendations from international societies like the American Society of Clinical Oncology and the American Society for Reproductive Medicine for women with restricted time to undergo FP.…”

“…[27][28][29] In addition, the collection and in vitro maturation of immature oocytes in connection with OTC provides an additional fertility potential, which could be essential especially for patients with cancers originating in the ovary. 29 Irrespective of all the above, it should always be prioritized to treat patients as quickly and safely as possible, and in our view OTC in most instances qualifies to be the preferred option for FP, which is in accordance with the current recommendations from international societies like the American Society of Clinical Oncology and the American Society for Reproductive Medicine for women with restricted time to undergo FP. 3,30 Finally, the choice of any fertility-preserving strategy should be an individual assessment of each woman depending on the specific indication, age, gonadotoxic treatment, psychological well-being, and future wishes for motherhood or ovarian function.…”