Health Problem: Advances in the technology used for the treatment of cancer have greatly improved survivorship rates in women with cancer. However, the cytotoxic effects of radiation and chemotherapy can result in premature ovarian failure and infertility, which may affect the estimated 25% of female cancer survivors of reproductive age. Estimates suggest that exposure to gonadotoxic cancer treatment leads to adverse pregnancy outcomes in up to 80% to 90% of patients.

Technology Description: Ovarian tissue cryopreservation (OTC) involves harvesting and freezing ovarian tissue, thus preserving oocytes in primordial follicles located in the ovarian cortex. The ovarian tissue can subsequently be autotransplanted after gonadotoxic treatment has ended and the patient is in remission.

Controversy: Oocyte and embryo cryopreservation are the standard methods for fertility preservation in postpubescent adolescents and women who will be receiving gonadotoxic therapy. Neither of these methods are viable options for prepubescent children, and embryo cryopreservation requires either a male partner or donor sperm. Since oocyte and embryo cryopreservation require ovarian stimulation, gonadotoxic therapy would be delayed 2 to 4 weeks. In contrast, OTC may be performed in prepubescent girls, can be performed immediately so that treatment can commence, and does not require a male component. In addition, autotransplantation of preserved ovarian tissue can restore ovarian function in women with treatment-induced premature ovarian failure. However, retrieval and transplantation of ovarian tissue are more invasive than oocyte retrieval, and transplantation of ovarian tissue carries a potential risk of reseeding certain cancers.

Key Questions

  • Does OTC and transplantation preserve fertility in women who have undergone gonadotoxic cancer treatments?

  • How does OTC and transplantation compare with other methods to preserve fertility after gonadotoxic cancer treatment?

  • Are OTC and transplantation safe?

  • Have definitive patient selection criteria been identified for OTC?

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