Human ovarian tissue cryopreservation: indications and feasibility

Abstract

Cryopreservation of ovarian tissue may be systematically proposed to young women and girls at risk of becoming sterile as a result of gonadotoxic treatment.

Preservation of Fertility in Pediatric and Adolescent Patients With Cancer

“…45,50,51 Because of their large size, water content, and chromosomal architecture, mature female oocytes are extremely fragile. The spindle apparatus of the chromosome is easily damaged by intracellular ice formation during the freezing or thawing process.…”

“…45 Within this context, it is the only method that can be offered to prepubertal girls. 50 There are a large number of immature oocytes in the ovarian cortex at this age, when the primordial follicles contain prophase I oocytes. This technique has been accomplished in children as young as 2.7 years of age, and the chance of later restoring fertility should be higher, theoretically, because the ovarian cor-tex contains an increased number of primordial and primary follicles in younger children.…”

Ovarian cryopreservation for fertility preservation: indications and outcomes

“…In this series, two patients had chemotherapy prior to cryopreservation, the first, and one of the women with systemic lupus erythematosis (SLE) who had previously received some cyclophosphamide. Others have argued that cryopreservation after chemotherapy may be appropriate (Poirot et al 2002, Meirow et al 2007, although the health of oocytes/follicles cryopreserved under those conditions is uncertain and may increase the risk to a subsequent pregnancy due to the DNA-damaging mechanism of action of some chemotherapeutic agents. A recent study has demonstrated increased oocyte vacuolisation and granulosa cell nuclear abnormalities after chemotherapy (Abir et al 2008), supporting the practice of confining cryopreservation to before treatment.…”

“…Many have proposed unilateral oophorectomy, and this has been the method used in some reports , Poirot et al 2002, Schmidt et al 2005, Andersen et al 2008. We have generally avoided this, other than in the case of our youngest patient who was to receive chemotherapy and pelvic radiotherapy.…”

“…As in a previous report (Poirot et al 2002), we have included women with non-malignant conditions requiring cytotoxic chemotherapy, i.e. cyclophosphamide for SLE and other rheumatological conditions.…”