Preservation of Female Fertility

Abstract

Chemotherapy and radiation treatment for malignancies or other conditions such as hematologic and autoimmune disorders, have resulted in improved survival rates but may lead to sterility. Women who postpone conception until late reproductive years are also at increased risk to become infertile. The purpose of our review is to evaluate advances and techniques for fertility preservation. We performed a literature search using the keywords fertility preservation, vitrification, oocytes, embryo, ovarian cryopreservation, and ovarian suspension and conducted the search in MEDLINE, EMBASE, and the Cochrane Database of systematic reviews. The results show that today, it is possible to cryopreserve oocytes, embryos, or ovarian tissue. The most commonly used technique remains embryo cryopreservation. Another improvement is the development of vitrification or rapid freezing technique. For women undergoing local pelvic radiation, one should consider ovarian suspension. Medical professionals, patients, and their families should be aware that in some conditions, the reproductive function can be preserved. Although one cannot guarantee future fertility, a realistic hope for women at risk of having premature ovarian failure can now be offered.

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

“…Thus, until recently, cryopreservation of human oocytes was defined as generally inefficient procedure and its application was restricted to the very special situations [29,[34][35][36][37]. The slow freezing remains widely used for oocyte storage but vitrification has progressively emerged as an alternative technique [29,33,[37][38][39][40][41].…”

“…This procedure limits the problem of cryoinjury by avoiding ice crystal formation and exerts a less detrimental effect on meiotic spindle [29,33,39,40,42]. In fact, Tulandi et al [35] have suggested that the pregnancy rates after oocyte vitrification are approximately twice as high as after traditional freezing (10-21 % vs 21-45 %, respectively). In particular, Kim et al [33] observed 285 vitrified oocytes documenting a 72 % of fertilization and 45 % of implantation rate.…”

Ovarian reserve and oocyte maturity in women with malignancy undergoing in vitro maturation treatment

“…Treatments include chemotherapy and radiation that often results in premature ovarian failure and sterility. To preserve fertility and ovarian function, cryopreservation of oocytes, embryo, or ovarian tissue has been performed (3).…”

Nonmalignant Diseases and Treatments Associated with Primary Ovarian Failure: An Expanded Role for Fertility Preservation

“…59 Success has been limited by available oocyte freezing techniques, although recent advances have been made with an alternative freezing technique, vitrification, with some groups reporting 81% survival and 45% clinical pregnancy per cycle. 93 Oocyte cryopreservation is still considered experimental by the American Society of Reproductive Medicine and, thus, is performed under Institutional Review Board (IRB) protocols at many centers. 94 Ovarian tissue cryopreservation for subsequent transplantation or in vitro follicle maturation is an investigational option for patients who do not have a partner, who are unable to undergo ovarian stimulation (e.g., prepubertal female), or who are unable to delay treatment long enough to undergo ovarian stimulation (Fig.…”

“…96,97 There have been case reports of successful live births after orthotopic ovarian tissue transplantation [98][99][100][101][102] ; however, there remain concerns about reseeding of malignant cells and the long-term viability of the grafts. 93 In vitro growth of follicles isolated from cryopreserved ovarian tissue, followed by in vitro maturation to produce oocytes competent for fertilization and implantation, is an active area of investigation [103][104][105][106][107] (Fig. 1).…”