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Review
. 2024 Apr 15;25(8):4360.
doi: 10.3390/ijms25084360.

Current Fertility Preservation Steps in Young Women Suffering from Cancer and Future Perspectives

Alicia Marco  1 , Marta Gargallo  2 , Jesús Ciriza  2   3 , Ariella Shikanov  4   5   6 , Laura Baquedano  7 , Javier García Pérez-Llantada  8 , Clara Malo  2   3
Affiliations
Review

Current Fertility Preservation Steps in Young Women Suffering from Cancer and Future Perspectives

Alicia Marco et al. Int J Mol Sci. .

Abstract

Childhood cancer incidence, especially in high-income countries, has led to a focus on preserving fertility in this vulnerable population. The common treatments, such as radiation and certain chemotherapeutic agents, though effective, pose a risk to fertility. For adult women, established techniques like embryo and egg freezing are standard, requiring ovarian stimulation. However, for prepubescent girls, ovarian tissue freezing has become the primary option, eliminating the need for hormonal preparation. This review describes the beginning, evolution, and current situation of the fertility preservation options for this young population. A total of 75 studies were included, covering the steps in the current fertility preservation protocols: (i) ovarian tissue extraction, (ii) the freezing method, and (iii) thawing and transplantation. Cryopreservation and the subsequent transplantation of ovarian tissue have resulted in successful fertility restoration, with over 200 recorded live births, including cases involving ovarian tissue cryopreserved from prepubescent girls. Despite promising results, challenges persist, such as follicular loss during transplantation, which is attributed to ischemic and oxidative damage. Optimizing ovarian tissue-freezing processes and exploring alternatives to transplantation, like in vitro systems for follicles to establish maturation, are essential to mitigating associated risks. Further research is required in fertility preservation techniques to enhance clinical outcomes in the future. Ovarian tissue cryopreservation appears to be a method with specific benefits, indications, and risks, which can be an important tool in terms of preserving fertility in younger women.

Keywords: cancer treatment; cryopreservation; fertility preservation; follicular loss; ovarian tissue.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagram of the ovarian tissue freezing process. Created by BioRender. Figure reproduced from Chen et al. 2022 [9].
Figure 2
Figure 2
Hematoxylin eosin (HE) staining of fresh human ovarian cortex tissue and follicles. ((A) ×50 and (B) ×100). Follicle stages were classified using the following criteria: primordial (one layer of flattened granulosa cells), ×200 (C); primary (one layer of fully expanded, cuboidal granulosa cells), ×200 (D); secondary indicated with an arrow (two distinct layers of expanded, granulosa cells), ×200 (E); antral (with visible > antrum), ×100 (F) [19].
Figure 3
Figure 3
Extracorporeal ovarian extraction procedure [26]. (A) Port sites locations; 5 mm at the umbilicus, 5 mm in the right lower quadrant, 12 mm in the left suprapubic area. (B) Placement of the traction suture through the left ovary. (C) Removal of the 12 mm trocar from the field and utilizing the traction suture to deliver the left ovary to an ex vivo position. May require extension of the incision. (D) With suture stays and intermittent vascular control, a wedge resection of the left ovary performed with scalpel. (E) Following removal of the ovarian tissue, hemostasis is obtained with electrocautery and the ovarian capsule is closed with running vicryl suture. (F) Ovary is placed back in its native position and hemostasis ensured.
Figure 4
Figure 4
Scheme of issues associated with different freezing rates. Created in BioRender. Figure reproduced from Murray and Gibson (2022) [40].
Figure 5
Figure 5
Operation scheme of the Kitazato kit for ovarian tissue cryopreservation. Created in BioRender. Figure reproduced from Kitazato Coorporation [45].
Figure 6
Figure 6
PI3K Pathway. Created in BioRender. Figure reproduced from Dolmans et al. 2021 [51].
See this image and copyright information in PMC

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