Fertility preservation in women for medical and social reasons: Oocytes vs ovarian tissue. (January 2021)

• Record Type: Journal Article
• Authors: Dolmans, Marie-Madeleine; Donnez, Jacques
• Is Part Of: Best practice & research. Volume 70(2021)
• Page Start: 63
• Page End: 80
• Publication Date: 2021-01
• Subjects: Ovarian tissue -- Oocytes -- Transplantation -- Vitrification -- Fertility preservation -- Freezing; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2020.06.011
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: 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. Highlights: 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.