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New advances in ovarian autotransplantation to restore fertility in cancer patients

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Abstract

Human ovary autotransplantation is a promising option for fertility preservation of young women and girls undergoing gonadotoxic treatments for cancer or some autoimmune diseases. Although experimental, it resulted in at least 42 healthy babies worldwide. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed for all relevant full-text articles published in English from 1 January 2000 to 01 October 2015 in PubMed to explore the latest clinical and research advances of human ovary autotransplantation. Human ovary autotransplantation involves ovarian tissue extraction, freezing/thawing, and transplantation back into the same patient. Three major forms of human ovary autotransplantation exist including (a) transplantation of cortical ovarian tissue, (b) transplantation of whole ovary, and (c) transplantation of ovarian follicles (artificial ovary). According to the recent guidelines, human ovary autotransplantation is still considered experimental; however, it has unique advantages in comparison to other options of female fertility preservation. Human ovary autotransplantation (i) does not need prior ovarian stimulation, (ii) allows immediate initiation of cancer therapy, (iii) can restore both endocrine and reproductive ovarian functions, and (iv) may be the only fertility preservation option suitable for prepubertal girls or for young women with estrogen-sensitive malignancies. As any other fertility preservation option, human ovary autotransplantation has both advantages and disadvantages and may not be feasible for all cases. The major challenges facing this option are how to avoid the risk of reintroducing malignant cells and how to prolong the lifespan of ovarian transplant as well as how to improve artificial ovary results.

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Authors’ contribution

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany

    Mahmoud Salama

  2. Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 East Superior Street, Room 10-119, Chicago, IL, 60611, USA

    Teresa K. Woodruff

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  1. Mahmoud Salama
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Correspondence to Teresa K. Woodruff.

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Key message (implications for practice): Human ovary autotransplantation involves ovarian tissue extraction, freezing/thawing, and transplantation back into the same patient. Although experimental, it is a promising option for fertility preservation of young women and girls undergoing gonadotoxic treatments for cancer or some autoimmune diseases. To date, it resulted in at least 42 healthy babies worldwide. The major challenges facing this option are how to (i) avoid the risk of reintroducing malignant cells, (ii) prolong the lifespan of ovarian transplants, (iii) improve artificial ovary results, and (iv) establish an accurate international registry.

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Salama, M., Woodruff, T.K. New advances in ovarian autotransplantation to restore fertility in cancer patients. Cancer Metastasis Rev 34, 807–822 (2015). https://doi.org/10.1007/s10555-015-9600-2

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