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Ovarian cryopreservation for fertility preservation: indications and outcomes.

R Anderson, University of Edinburgh, Edinburgh, United Kingdom
H Wallace, University of Edinburgh, Edinburgh, United Kingdom
D Baird, University of Edinburgh, Edinburgh, United Kingdom

Correspondence: Richard Anderson, Email: r.anderson{at}hrsu.mrc.ac.uk

Abstract

Female fertility preservation provides significantly different challenges to that for the male, with the only established method being cryopreservation of embryos thus necessitating the involvement of a male. Other, experimental, options include oocyte or ovarian tissue cryopreservation. The latter has been regarded as a potential method for more than a decade, but has resulted in the birth of only 5 babies. It is not possible to be certain how many women have had ovarian tissue cryopreserved. Oocyte cryopreservation also remains experimental, but approximately 100 fold more babies have been born through this technique over the last two decades. Ovarian tissue cryopreservation has the potential advantages of preservation of a large number of oocytes within primordial follicles, it does not require hormonal stimulation when time is short, and indeed may be appropriate for the prepubertal. Disadvantages include the need for an invasive procedure, and the uncertain risk of ovarian contamination in haematological and other malignancies. We here review this approach in the context of our own experience of 36 women, highlighting issues of patient selection especially in the young, and uncertainties over the effects of cancer treatments on subsequent fertility. Of these 36 women, 11 have died, but 5 have had spontaneous pregnancies. So far none having requested reimplantation of their stored ovarian tissue. Ovarian cryopreservation appears to be a potentially valuable method for fertility preservation, but the indications and approaches best used remain unclear.