[How to preserve female fertility before cancer treatments?]. / Comment préserver la fertilité féminine lors du traitement d'un cancer en vue de rendre possible une grossesse ultérieure?

Over the past decades, major advances in diagnosis and treatment have markedly improved the rates of cure for many young adults and children cancers. As a result, the field of fertility preservation (FP) has developed to overcome the adverse effects of cancer treatments on gonadal function. The strategy of FP will depend on patient's age, the puberty status, and the time frame before the initiation of gonadotoxic treatments. Embryo or oocyte cryopreservation after controlled ovarian hyperstimulation is currently the most established technique of FP, but ovarian tissue freezing may also be offered despite it is still considered experimental. More recently, in vitro maturation (IVM) of oocyte has been proposed in the strategy of FP since it does not require ovarian stimulation and can be performed at any time of the menstrual cycle. Therefore, IVM represents an attractive approach for urgent FP or/and in patients suffering from estrogen-sensitive cancers. In addition, GnRH agonists administration during chemotherapy has also been considered as a technique of FP, with controversial results.

Ovarian tissue and follicle transplantation as an option for fertility preservation.

OBJECTIVE: To review and summarize data from the scientific literature on ovarian tissue and follicle transplantation as an option for fertility preservation. DESIGN: Review of pertinent literature. SETTING: University hospital. PATIENT(S): Women having undergone ovarian tissue transplantation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Review of the literature. RESULT(S): Over the last decade, the field of ovarian transplantation and cryopreservation has significantly progressed, becoming applicable in humans. Indeed, fresh and frozen cortical ovarian tissue transplantations have been successfully reported worldwide, resulting in around 28 healthy babies. Although ovarian-tissue harvesting seems to be safe, the risk of reimplantation of cancer from ovarian cortical transplants cannot be estimated at this time. As a consequence, auto-transplantation of ovarian tissue in women having suffered from systemic hematological malignancies is not recommended. In these situations, reimplantation of isolated ovarian follicles might represent an interesting option in the future. CONCLUSION(S): Although the clinical experience is limited, the robust results obtained open new perspectives for the management of premature ovarian failure resulting or not from gonadotoxic treatments.