Ovarian tissue cryopreservation and transplantation in patients with cancer

Abstract

Chemotherapy and radiotherapy improved survival rates of patients with cancer. However, they can cause ovarian failure and infertility in women of reproductive age. Infertility following cancer treatment is considered a major quality of life issue. Ovarian tissue cryopreservation and transplantation is an important option for fertility preservation in adult patients with cancer who need immediate chemotherapy or do not want to undergo ovarian stimulation. Ovarian tissue freezing is the only option for preserving the fertility of prepubertal patients with cancer. In a recent review, it was reported that frozen-thawed ovarian transplantation has lead to about 90 live births and the conception rate was about 30%. Endocrine function recovery was observed in 92.9% between 3.5 and 6.5 months after transplantation. Based on our review, ovarian tissue cryopreservation and transplantation may be carefully considered before cancer treatment in order to preserve fertility and endocrine function in young cancer survivors.

Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity

“…Although the survival rate of cancer patients has dramatically improved due to development of chemotherapy, ovarian toxicity induced by chemotherapy is a major complication. Gonadotoxic chemotherapy during reproductive age can lead to iatrogenic primary ovarian insufficiency (POI), and loss of follicular reserve that depends on the type, dose, duration, and combination of chemotherapeutic agents, and disease stage, as well as patient age [ 14 , 15 ]. It has been reported that 53–89% of chemotherapy-induced POI occurs in patients with breast cancer [ 16 ].…”

“…Oocyte cryopreservation, like embryo cryopreservation, is considered a gold standard technique for fertility preservation in cancer patients [ 15 , 73 ]. In 2000, the United Kingdom (UK) Human Fertilization and Embryology Authority (HFEA) allowed the use of frozen oocytes for fertility preservation [ 74 ].…”

“…Fourth, the hormonal function of the ovary can be restored, which improves the quality of life for young women. Finally, this technique does not need ovarian stimulation or a sperm donor [ 15 , 88 , 89 , 90 ].…”

“…According to data from Donnez’s group, pregnancy and live birth rates were 41% and 36% in 22 women who underwent ovarian tissue cryopreservation and auto-transplantation [ 10 ]. Patient age at the time of cryopreservation is a major predictive factor affecting improved future pregnancy outcomes [ 15 ]. In general, an age of 35 years is regarded as the upper limit for ovarian tissue freezing, because primordial follicle count significantly decreases with age [ 109 ].…”

“…It has been reported that approximately 3.5 to 6.5 months were required for an increase in estradiol and a decrease in FSH levels. After ovarian tissue transplantation, restoration of ovarian function has been reported consistently, along with an increasing number of successful live births [ 15 ].…”