The feasibility of ovarian tissue cryopreservation in selected females after hematopoietic stem cell transplantation

We evaluated whether ovarian tissue cryopreservation (OTC) is a viable option for girls and young women who have already undergone hematopoietic stem cell transplantation (HSCT). We enrolled 142 patients who underwent OTC either before or after HSCT. Participants were categorized into three groups: "after HSCT group" (n = 16), "no-chemo group" before OTC (n = 75), and "chemo group" before OTC (n = 51). The after HSCT cohort had a mean age of 12.06 years at OTC, with half being pre-pubertal. Comparative analysis across age (0-12 and 13-24 years) revealed that the after-HSCT group consistently presented with significantly elevated FSH and diminished AMH levels relative to the no-chemo group. Ovarian volume per ovary was also markedly reduced in the after-HSCT group compared to the no-chemo group across all ages. Crucially, the estimated total follicle count per ovary was significantly lower in the after-HSCT group than in both pre-HSCT groups among 0-12 years, and versus the "no-chemo group" in 13-24 years. This confirms pre-HSCT fertility preservation as the paramount strategy. However, OTC post-HSCT emerges as a viable salvage option for carefully selected patients, underscoring the need for long-term follow-up to identify candidates and expand fertility possibilities in survivorship care.