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Cryopreservation of female reproductive potential

https://doi.org/10.1016/j.bpobgyn.2018.08.005Get rights and content

Highlights

  • Oocyte vitrification offers women the best option to preserve fertility.

  • Ovarian tissue cryopreservation using a slow cooling preserves large numbers of primordial follicles.

  • There is a potential risk of malignant contamination within the ovarian tissue removed from patients with cancer.

Abstract

Storing female reproductive potential can offer enhanced prospects for future conception in women whose fertility is threatened by cytotoxic therapies. Human female reproductive potential can be cryopreserved and stored at very low temperatures as embryos or gametes. Gamete (oocyte) cryopreservation circumvents potential issues associated with ownership when future use is being considered and may, therefore, be more generally acceptable as an approach. Advances in the technology, in particular the clinical application of vitrification, have significantly improved the outcomes from mature oocyte cryopreservation, which are now comparable to those from embryo cryopreservation. In cases where mature oocyte cryopreservation is not feasible, ovarian cortex containing primordial follicles can be cryopreserved, and over 100 births have now been reported following grafting of stored ovarian tissue. Ovarian tissue cryopreservation is now an established approach to preserve future fertility for young women; however, the efficiency is difficult to determine particularly for the prepubertal tissue with a scarcity of data.

Section snippets

Background

The ability to store biological material at very low temperatures over extended periods of time (cryopreservation) has provided potential solutions in a wide range of biological and clinical situations. Perhaps nowhere is this more evident than in its application in human assisted reproductive technologies (ARTs). In this chapter, the specific role of the cryopreservation of female reproductive potential in current clinical practice is reviewed.

Evolution of technology

Subzero storage of animal gametes, both male and female, was first reported in the 1950s, but it was not until the 1980s that the first birth from a frozen human oocyte were reported [12]. At this time, animal studies raised major concerns regarding the risk of generating aneuploid embryos, because of the temperature sensitivity of the meiotic spindle involved in anchoring chromosomes, and the potential for the formation of abnormal foetuses. However, there were also concerns that the

Advantages in certain cases

For prepubertal girls, young adolescent girls and those requiring urgent treatment, ovarian tissue storage is the only realistic fertility preservation option. It has, however, been suggested, based on the limited number of oocytes obtained from a single stimulation cycle, that cryopreserving ovarian tissue in young women may offer a higher prospect of future fertility than oocyte cryopreservation. Although an invasive procedure is required to remove ovarian tissue, this can be performed in

Specific concerns relating to residual malignant cells within cryopreserved tissue

The relative risk of potential malignancy within the ovarian tissue has been reviewed for various cancers ([70]*) with high risk status identified in the cases of ovarian cancers and leukaemia (see later). However, the routine histological evaluation of ovarian tissue presenting for cryopreservation (irrespective of estimated risk) has detected malignancy in an area attached to the ovary that contained Hodgkin's lymphoma cells in one patient [71] and Ewing's sarcoma in the medullar area of the

Future research

Further research is necessary to establish the risk of malignant cells within tissue from patients with leukaemia and whether these can be eliminated selectively from the tissue. Isolation of follicles free of stromal cells may reduce contamination [80], and it has been postulated that, after the depletion of leukemic cells, the follicles could be reconstructed in a matrix to form a mini or artificial ovary and subsequently grafted to the patient. A number of matrix compositions are presently

Conclusion

Female fertility cryopreservation has evolved from the research phase into the present multi-faceted approach, thereby offering options to women presenting with anticipated loss of fertility. Although many questions remain to be investigated, a review of the technical advances in this field that underpin clinical application gives an important insight into the field of female fertility preservation and highlights the challenges ahead.

Practical points

  • Mature oocyte cryopreservation can now

Funding

Internal funding by Melbourne IVF, Australia.

Conflict of interest

The authors have no conflict of interest.

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