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  • Review Article
  • Published:

Fertility preservation in women

Nature Reviews Endocrinology volume 9, pages 735–749 (2013)Cite this article

Subjects

Key Points

  • Approximately 10% of cancers in women occur in those <45 years old, and in the USA, the number of new cases of invasive cancer diagnosed in women during 2012 was almost 800,000

  • Chemotherapy, radiotherapy, surgery and bone marrow transplantation have led to a considerable improvement in survival rates, but these treatments can result in premature ovarian failure (POF)

  • The risk of POF depends on the follicular reserve, the age of the patient and the type and dose of drugs used

  • Different options exist to preserve fertility in women at risk of POF, including ovarian transposition, embryo and oocyte cryopreservation, and ovarian tissue cryopreservation

  • In prepubertal girls or patients requiring immediate chemotherapy, ovarian tissue cryopreservation is the only method currently available

  • Medical therapy (with a gonadotropin-releasing hormone agonist) before chemotherapy is still controversial

Abstract

In women, ∼10% of cancers occur in those <45 years old. Chemotherapy, radiotherapy and bone marrow transplantation can cure >90% of girls and young women with diseases that require such treatments. However, these treatments can result in premature ovarian failure, depending on the follicular reserve, the age of the patient and the type and dose of drugs used. This article discusses the different fertility preservation strategies: medical therapy before chemotherapy; ovarian transposition; embryo cryopreservation; oocyte vitrification; and ovarian tissue cryopreservation. The indications, results and risks of these options are discussed. Whether medical therapy should be used to protect the gonads during chemotherapy remains a source of debate. Fertility preservation needs to be completed before chemotherapy and/or irradiation is started and might take 2–3 weeks with established techniques such as embryo or oocyte cryopreservation. Further studies are needed in patients with cancer to confirm the excellent outcomes obtained in patients without cancer or in egg donation programmes. For prepubertal girls or cases where immediate therapy is required, cryopreservation of ovarian tissue is the only available option. Finally, possible future approaches are reviewed, including in vitro maturation of nonantral follicles, the artificial ovary, oogonial stem cells and drugs to prevent follicle loss.

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Figure 1: The ovarian reserve: the model that best fits histological data according to Wallace and Kelsey.
Figure 2: FSH values in the months after orthotopic transplantation of frozen–thawed ovarian tissue.
Figure 3: Options for cryopreservation of ovarian tissue and reimplantation.
Figure 4: Fertility preservation methods in women at risk of premature ovarian failure.

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Authors and Affiliations

  1. Société de Recherche pour l'Infertilité, Avenue Grandchamp, 143, Brussels, B-1150, Belgium

    Jacques Donnez

  2. Service de Gynécologie, Cliniques Universitaires Saint-Luc, Brussels, B-1200, Belgium

    Marie-Madeleine Dolmans

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  1. Jacques Donnez
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Both authors contributed equally to all aspects of the manuscript.

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Correspondence to Jacques Donnez.

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J. Donnez is a board member of PregLem SA and has received payment for lectures and scientific presentations at congresses from Ferring, MSD, Organon and Serono. M.-M. Dolmans declares no competing interests.

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Donnez, J., Dolmans, MM. Fertility preservation in women. Nat Rev Endocrinol 9, 735–749 (2013). https://doi.org/10.1038/nrendo.2013.205

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