New advances in ovarian autotransplantation to restore fertility in cancer patients

Abstract

Human ovary autotransplantation is a promising option for fertility preservation of young women and girls undergoing gonadotoxic treatments for cancer or some autoimmune diseases. Although experimental, it resulted in at least 42 healthy babies worldwide. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed for all relevant full-text articles published in English from 1 January 2000 to 01 October 2015 in PubMed to explore the latest clinical and research advances of human ovary autotransplantation. Human ovary autotransplantation involves ovarian tissue extraction, freezing/thawing, and transplantation back into the same patient. Three major forms of human ovary autotransplantation exist including (a) transplantation of cortical ovarian tissue, (b) transplantation of whole ovary, and (c) transplantation of ovarian follicles (artificial ovary). According to the recent guidelines, human ovary autotransplantation is still considered experimental; however, it has unique advantages in comparison to other options of female fertility preservation. Human ovary autotransplantation (i) does not need prior ovarian stimulation, (ii) allows immediate initiation of cancer therapy, (iii) can restore both endocrine and reproductive ovarian functions, and (iv) may be the only fertility preservation option suitable for prepubertal girls or for young women with estrogen-sensitive malignancies. As any other fertility preservation option, human ovary autotransplantation has both advantages and disadvantages and may not be feasible for all cases. The major challenges facing this option are how to avoid the risk of reintroducing malignant cells and how to prolong the lifespan of ovarian transplant as well as how to improve artificial ovary results.

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…52 Although evidence supporting the effectiveness and safety of ovarian tissue cryopreservation is scare, a few systematic reviews have supported its use for fertility preservation in cancer patients. 120,121 This procedure would not be appropriate for some women with cancer, where there is a potential for reintroduction of malignant cells that could occur with grafting. Although ovarian tissue cryopreservation is still considered investigational at some institutions, it may be discussed as an option for fertility preservation, if available.…”

Autologous Transplantation of Cryopreserved Ovarian Tissue to the Upper Extremity for the Preservation of Ovarian Function in Young Patient with Cervical Carcinoma

“…About 20% to 40% of patients would be suggested to receive this radical surgery followed by postoperative radiotherapy based on the standardized local tumor parameters such as lymph node metastases, parametrial involvement, affected surgical margins, and unfavorable local tumor factors [16,17]. Generally for a stage Ib2 cervical cancer patient underwent combined surgery and radiotherapy, the chances of tumor recurrence within 5 years is 9.3% and the survival rate is 90% according to the statistics in our institution, which is comparable to the calculation in other cervical cancer surgery study [22].…”

“…In conclusion, autotransplantation of cryopreserved ovarian cortex for ovarian function preservation is a viable option for cervical cancer patients to gain the quality of life and avoid the suffering from conventional menopause hormone therapy. [17,18]. Therefore, this study chose slow-freezing for cryopreservation of ovarian tissue.…”

Gynecologic Issues in the Pediatric and Adolescent Patient with Cancer

“…The cryopreserved tissue is later re-implanted. At least 42 live births have been reported worldwide using ovarian tissue cryopreservation in patients who were pubertal at time of ovarian tissue cryopreservation [47]. Transplanted tissue may additionally restore hormonal function in addition to reproductive capacity; however, function is typically limited and has been shown to last 9 months to 3 years [48,49].…”