Uterus Cryopreservation From Experimental Models to Clinical Application: A Translational Review

This narrative review provides a preclinical, hypothesis-generating overview of uterine cryopreservation using animal models, with particular emphasis on large-animal experimental systems. Cryopreservation of solid organs remains one of the most significant challenges in preclinical and translational research, driven by persistent organ shortages, limited ischemia tolerance, and logistical and immunological barriers inherent to current transplantation paradigms. Despite decades of progress in cryobiology, no solid organ has yet been successfully cryopreserved, transplanted, and shown to sustain long-term functional outcomes in humans. In this context, the porcine uterus has gained attention as an experimental model for whole-organ preservation because of its structural and functional complexity combined with its non-vital status, offering an ethically acceptable and physiologically relevant platform for methodological development. This narrative review, informed by a structured literature search, examines experimental studies of uterine cryopreservation in animal models. A comprehensive search identified 43 relevant publications, of which 29 were included based on predefined relevance criteria and qualitative appraisal of methodological reporting quality. The synthesis focuses on cryoprotectant formulations, slow-freezing and vitrification strategies, and investigational rewarming approaches, including nanowarming, with particular attention to the porcine uterus as a preclinical model closely approximating human uterine anatomy and physiology. Available evidence indicates that controlled slow-freezing protocols using permeable cryoprotectants can preserve uterine histological architecture and retain partial post-thaw myometrial contractility under experimental conditions. Functional data derive predominantly from small-animal models and limited porcine uterine studies, while robust organ-level comparisons between slow freezing and vitrification remain unavailable. Although advanced rewarming technologies have demonstrated improved thermal uniformity in non-uterine large-organ models, their application to intact uterine cryopreservation remains investigational. Collectively, current evidence supports uterine cryopreservation, particularly in porcine models, as a preclinical, hypothesis-generating framework for whole-organ preservation research rather than a clinically established strategy. Given the absence of successful clinical transplantation of any cryopreserved solid organ and the lack of reproductive outcome data, findings should be interpreted cautiously. Continued standardized large-animal studies incorporating functional, vascular, and reproductive endpoints are essential to further define this frontier field before uterine organ banking or any clinical application can be responsibly considered.