Clinical dilemmas in ovarian tissue cryopreservation

Ovarian tissue cryopreservation (OTC) is increasingly offered globally as a fertility preservation strategy for both post-pubertal women and pre-pubertal girls, with subsequent re-implantation of cryopreserved ovarian cortex resulting in a rapidly growing number of livebirths. There remains very limited evidence of efficacy from tissue stored when the patient was pre-pubertal or from conditions affecting the ovary directly e.g. Turner syndrome. Although OTC is becoming a more established practice, several clinical dilemmas remain from a practical and ethical standpoint. This review discusses the challenges regarding optimal patient selection for the procedure, the utilisation of OTC in patients with a poor prognosis, the potential of reimplantation of tissue contaminated with malignant cells and the role of OTC in those with an intrinsic ovarian disorder. Ovarian tissue cryopreservation (OTC) is increasingly offered globally as a fertility preservation strategy for both post-pubertal women and pre-pubertal girls, with subsequent re-implantation of cryopreserved ovarian cortex resulting in a rapidly growing number of livebirths. There remains very limited evidence of efficacy from tissue stored when the patient was pre-pubertal or from conditions affecting the ovary directly e.g. Turner syndrome. Although OTC is becoming a more established practice, several clinical dilemmas remain from a practical and ethical standpoint. This review discusses the challenges regarding optimal patient selection for the procedure, the utilisation of OTC in patients with a poor prognosis, the potential of reimplantation of tissue contaminated with malignant cells and the role of OTC in those with an intrinsic ovarian disorder.