Since the first live birth after orthotopic transplantation of frozen–thawed ovarian tissue, >40 babies have been born. It is time to consider fertility preservation in women as one of the foremost challenges of the next decade and to offer women facing the risk of induced or iatrogenic premature menopause the best chances of becoming mothers.
Heterotopic transplantation has also been attempted, with consistent restoration of endocrine function; nonetheless, its clinical value remains questionable as it may not provide an optimal environment for follicular development, possibly because of differences in temperature, pressure, paracrine factors and blood supply.
Finally, orthotopic allo-transplantation of fresh human ovarian tissue has been successfully attempted between monozygotic twins and also between genetically different sisters.
The next step in this field will be the development of an artificial ovary, using, as a support, a biodegradable scaffold made of an alginate matrigel matrix onto which isolated preantral follicles and ovarian cells can be grafted.
Introduction
Significant developments in cancer therapy over recent decades have led to a dramatic improvement in survival rates, and many cancers can now be cured, raising the important issue of subsequent quality of life . Unfortunately, treatments such as chemotherapy, radiotherapy and/or surgery result in premature ovarian failure (POF) in some instances, robbing these women of the chance of conceiving a child .
This is particularly pertinent for young women wishing to start a family once in disease remission. Indeed, the number of new cases of invasive cancer in women in the USA was approximately 790,740 in 2012, and around 10% of these cases were in women aged <45 years .
Non-malignant systemic diseases like autoimmune and haematological disorders may also require chemotherapy or radiotherapy, often associated with bone marrow transplantation (BMT) . Impairment of ovarian function after BMT is generally linked to increased age at the time of treatment and use of total body irradiation prior to transplantation .
Ovaries are particularly sensitive to cytotoxic drugs, especially alkylating agents, which are likely to lead to gonadal dysfunction . Cyclophosphamide is the alkylating agent implicated in causing most damage to oocytes and granulosa cells depending on dose, while a combination of abdominal ionizing radiation and alkylating agents leaves almost 100% of patients infertile .
Pelvic radiation therapy also causes POF, with exposure levels of 5–10 Gy known to be toxic to oocytes . Indeed, the human oocyte is very sensitive to radiation and as little as <2Gy may be enough to destroy 50% of primordial follicles .
This review evaluates the techniques and results of ovarian tissue transplantation.
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