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

Abstract

Although advances in cancer treatment and early diagnosis have significantly improved cancer survival rates, cancer therapies can cause serious side effects, including ovarian failure and infertility, in women of reproductive age. Infertility following cancer treatment can have significant adverse effects on the quality of life. However, established methods for fertility preservation, including embryo or oocyte cryopreservation, are not always suitable for female cancer patients because of complicated individual conditions and treatment methods. Ovarian tissue cryopreservation and transplantation is a promising option for fertility preservation in pre-pubertal girls and adult patients with cancer who require immediate treatment, or who are not eligible to undergo ovarian stimulation. This review introduces various methods and strategies to improve ovarian tissue cryopreservation and transplantation outcomes, to help patients and clinicians choose the best option when considering the potential complexity of a patient’s situation. Effective multidisciplinary oncofertility strategies, involving the inclusion of a highly skilled and experienced oncofertility team that considers cryopreservation methods, thawing processes and devices, surgical procedures for transplantation, and advances in technologies, are necessary to provide high-quality care to a cancer patient.

Role of Stem Cells in the Ovarian Tissue Cryopreservation and Transplantation for Fertility Preservation

“…The production of stem cells by oocytes could be the key to solving infertility [32]. Stem cells purified from ovarian GSCs may be an option for reproductive-aged cancer patients who are subjected to iatrogenic primary ovarian insufficiency, particularly prepubertal girls.…”

“…The use of anti-apoptotic agents, recombinant AMH, and growth factors has been shown to increase success rates. Experiments have been conducted to determine whether slow freezing or vitrification is superior for cryopreservation [32].…”

“…These currently investigated agents, as well as stem cells used to aid ovarian tissue cryopreservation and transplantation, have been researched to minimize follicle loss and aid follicle maturation (Table 1). Among the cryoprotectants used for slow freezing, ethylene glycol showed the highest follicle survival rate compared to dimethyl sulfoxide, propylene glycol, and glycerol [32]. The use of recombinant AMH, VEGF, and FGF2 has been shown to reduce initial follicle loss and improve revascularization [62][63][64].…”

Practical issues and research trends of oncofertility in gynecologic cancer

“…Immediately after transvaginal ovum pick-up, the patient's oocytes are frozen, but this process also takes over 2 weeks [31]. As of recently, ovarian tissue cryopreservation can also be performed [32]. One advantage of ovarian tissue cryopreservation is that no additional time is required to induce ovarian hyperstimulation, so there is no need to postpone anti-cancer treatment [32].…”

“…As of recently, ovarian tissue cryopreservation can also be performed [32]. One advantage of ovarian tissue cryopreservation is that no additional time is required to induce ovarian hyperstimulation, so there is no need to postpone anti-cancer treatment [32]. If these processes cannot be performed before treatment, ovum donation should be selected as the method for inducing pregnancy.…”