The future of human ovarian cryopreservation and transplantation: fertility and beyond

Objective: To review the current progress in ovarian cryopreservation and t ransplantation and to discuss the obstacles with the clinical application o f this technique. Design: The literature on ovarian cryopreservation and transplantation was reviewed to facilitate understanding and predict future directions. The stu dies related to this topic were identified through MEDLINE and other biblio graphic databases, focusing on the most recent developments. Conclusion(s): The experimental evidence for low-temperature storage of ova rian tissue is encouraging. Although restoration of fertility with cryopres erved ovarian grafts has been successful in various animals, there are unce rtainties about the optimum use of stored ovarian tissue in humans. Autotra nsplantation appears to be promising, but the potential risk of transmittin g malignant cells in women with cancer is of great concern. The maturation of primordial follicles with xenotransplantation is encouraging. but the ef ficacy and the safety of this method need further investigation. Furthermor e, the quality of oocytes that have been matured in a host animal is unknow n. The development of in vitro culture systems for oocyte maturation is sti ll in its infancy. There are many issues to be resolved in ovarian transpla ntation before the full clinical use of this emerging technique. Most of al l, there is an urgent need to optimize the freeze/thaw procedure and to fin d the means to protect grafts from ischemia-reperfusion injury. Nevertheles s, ovarian transplantation should prove to be clinically useful for women a t risk for premature ovarian failure. (Fertil Steril(R) 2001;75:1049-56. (C ) 2001 by American Society for Reproductive Medicine.).