Fertility preservation in women for medical and social reasons: Oocytes vs ovarian tissue

Approximately 10% of cancers occur in women under 45 years of age. Chemotherapy, radiotherapy, and bone marrow transplantation cure more than 90% of cancer in women, but can result in premature ovarian insufficiency depending on follicular reserve, age, and drugs used. Some benign diseases are also...

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Bibliographic Details
Published in:Best practice & research. Clinical obstetrics & gynaecology 2021-01, Vol.70, p.63-80
Main Authors: Dolmans, Marie-Madeleine, Donnez, Jacques
Format: Article
Language:English
Subjects:
Cryopreservation
Female
Fertility Preservation
Freezing
Humans
Neoplasms - drug therapy
Oocytes
Ovarian tissue
Pregnancy
Primary Ovarian Insufficiency - chemically induced
Primary Ovarian Insufficiency - prevention & control
Transplantation
Vitrification
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Summary:Approximately 10% of cancers occur in women under 45 years of age. Chemotherapy, radiotherapy, and bone marrow transplantation cure more than 90% of cancer in women, but can result in premature ovarian insufficiency depending on follicular reserve, age, and drugs used. Some benign diseases are also indications for fertility preservation, particularly those requiring chemotherapy (like thalassemia and lupus), recurrent endometriosis, and family history of premature menopause. Social reasons also account for a large proportion of women who wish to postpone pregnancy. This article discusses the two main strategies for fertility preservation, namely oocyte vitrification and ovarian tissue cryopreservation, examining the indications and results of these options. Oocyte cryopreservation is an effective approach, but further studies are needed in cancer patients to ensure the excellent outcomes obtained in women without cancer or in egg donation programs. For prepubertal girls or cases where immediate therapy is required, cryopreservation of ovarian tissue is the only available option. •Fertility preservation should be considered prior to each gonadotoxic treatment.•Embryo and oocyte cryopreservation are efficacious but need time for ovarian stimulation.•If there is no time for ovarian stimulation, ovarian tissue cryopreservation should be proposed.•Ovarian tissue cryopreservation should be proposed for prepubertal girls.•The orthotopic transplantation of frozen thawed tissue allows natural conception.
ISSN:1521-6934
1532-1932
DOI:10.1016/j.bpobgyn.2020.06.011