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

Author:

Marco Alicia1,Gargallo Marta2,Ciriza Jesús23,Shikanov Ariella456ORCID,Baquedano Laura7ORCID,García Pérez-Llantada Javier8,Malo Clara23

Affiliation:

1. Faculty of Medicine, University of Zaragoza, 50018 Zaragoza, Spain

2. Institute for Health Research Aragón (IIS Aragón), 50009 Zaragoza, Spain

3. Tissue Microenvironment (TME) Lab, Aragón Institute of Engineering Research (I3A), University of Zaragoza, 50018 Zaragoza, Spain

4. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA

5. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA

6. Cellular and Molecular Biology Program, University of Michigan, Ann Arbor, MI 48109, USA

7. Department of Gynecology, University Hospital Miguel Servat, 50009 Zaragoza, Spain

8. Hospital Viamed Montecanal, 50012 Zaragoza, Spain

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.

Publisher

MDPI AG

Reference74 articles.

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