[Indications for the cryopreservation of ovarian tissue. Study Group for the Cryopreservation of Ovarian Tissue].
A number of questions should be envisioned before proposing the indications for clinical use of ovarian tissue cryopreservation (OTC). With what goal is ovarian tissue being preserved? To protect ovarian function which includes the ovarian endocrine secretions and the monthly release of a mature oocyte assuring the fertility of the patient; preservation of fertility is in fact the key goal. To whom should OTC be offered? In theory, to all women whose ovarian function is threatened in a physiological, pathological or iatrogenic manner. In practice, the threat to the follicular reservoir occurring with cancer chemotherapy is the best established indication. Other indications may in the future also be deemed appropriate-when human clinical use of OTC will have proven itself effective. For the present, it is preferable to reserve OTC use to patients under 35 years old who, in whatever manner, would have undergone a very severe cutback of their follicular reserve. What quantity of ovarian tissue should be extracted? It seems to us preferable to only remove one ovary, thereby leaving the patients with the possibility of undergoing spontaneous fertility, so that the frozen tissue need only be used if the ovary left in place should lose its function. How should use of the frozen tissue be directed? Among the three theoretic possibilities: of tissue autograft, follicular maturation in vitro, and heterograft, only the autograft appears realizable in the near future. However, presently, pregnancies using this technology have only been obtained in three animal species. For the near future, it appears to us that resort to OTC must remain infrequent and only performed in the setting of clinical research protocols. Priority should be given to continued basic research as many key points of OTC practice still need to be clarified.
Aubard
Y
Y
Centre Hospitalier Universitaire de Limoges, Hôpital Universitaire Dupuypren, Limoges.
D015925:Cryopreservation; D005260:Female; D006801:Humans; D010053:Ovary / Q000637:transplantation; D014182:Transplantation, Autologous