Ovarian tissue cryopreservation for fertility preservation: indications, principles and future applications

Recent advances in cancer diagnosis and therapy have increased the 5-year survival rate. However, anticancer treatments are gonadotoxic; therefore, fertility preservation is recommended prior to the initiation of therapy to optimize future chances of conceiving. The only method for preserving fertility in prepubescent girls, also suitable for women, is ovarian tissue cryopreservation (OTC). Although approximately 250-300 births have been reported with this approach, significant variability in cryopreservation protocols is observed across fertility preservation centres. Importantly, the presence of residual disease in cryopreserved ovarian fragments will prevent the restoration of fertility. The primary aim of this review is to offer an overview of the impact of cancer and its treatment on female fertility, including the latest updates on novel therapies. This will help to refine fertility preservation indications - a growing concern in the oncofertility field. This review will also provide a comprehensive summary of the different procedures used for OTC, with the aim of standardizing protocols in clinical practice, and offer an updated overview of alternative, albeit experimental, approaches that are being developed to restore fertility and overcome the limitations of transplantation. This will highlight next-generation solutions for restoring the fertility of young female patients.