Improved oncological treatments permit increased survival rates, although cancer patients remain at risk of losing ovarian function. An attractive option for fertility preservation includes the use of immature oocytes, a strategy which can occur on a rapid timeline and without hormonal stimulation. As a result, cancer therapy can proceed promptly even in patients with hormone-sensitive tumors. Following retrieval, immature oocytes can be cryopreserved at either the immature germinal vesicle or the mature metaphase-II stage, i.e. either before or after in vitro maturation (IVM). We present a critical review of previous human studies on the cryopreservation of immature oocytes. Evaluations include in vitro developmental competence upon thawing/warming, or organization of the spindle and chromosomes. Reported successes vary, perhaps in relation to the source of the oocytes and protocols for cryopreservation and IVM. Weaknesses exist with the experimental designs implemented to date, so caution must be exercised before considering the use of immature oocytes to be a safe and reliable practice in the fertility preservation of cancer patients. To date, results indicate that with current protocols, it may be best to cryopreserve immature oocytes after IVM at the metaphase-II stage. Nonetheless, efficacy remains very low. Future efforts should tailor and optimize not only cryopreservation, but also IVM protocols for use in either germinal vesicle or metaphase-II oocytes, together with a comprehensive assessment of oocyte function and developmental competence to term. Despite current challenges, the burgeoning field of immature oocyte cryopreservation constitutes a promising option for cancer patients with impaired ovarian function.
KEY WORDS: immature oocyte, fertility preservation, cryopreservation, cancer, in vitro maturation
Why target immature oocytes in cancer patients?In the last few decades, the incidence of cancer and the likelihood of survival have risen across the globe. A little over 1 in 3 women in North America are diagnosed with cancer every year. This constitutes an overwhelming number of young women of reproductive age undergoing chemotherapy, radiotherapy, and other oncologic treatments; an estimated 9% of cancer survivors are 20-39 years old in the United States. Invasive cancers are treated aggressively through chemotherapy, radiotherapy and surgeries to remove cancerous cells and masses. Unfortunately such treatments create irreversible damage to the gonads and possible sterility (reviewed by Anchan and Ginsburg, 2010). Depending on the type and dose, oncological therapies may result in damage and/or loss of not only germ cells but also the supporting somatic compartments of the ovarian follicle. Due to the women's finite number of oocytes and the irreplaceable nature of the pool Int. J. Dev. Biol. 56: 919-929 (2012)