Fertility preservation in girls during childhood: is it feasible, efficient and safe and to whom should it be proposed?
BACKGROUND
In prepubertal and adolescent girls, fertility may be impaired by gonadotoxic treatments, repeat ovarian surgery or genetic disorders. Cryopreservation of ovarian cortex is an existing option to preserve fertility in these young girls at risk of premature ovarian failure (POF). The efficacy, feasibility and risks of ovarian cryopreservation in children must be assessed in order to validate the technique.


METHODS
Here, we conducted a review of ovarian cryopreservation in adults and, more specifically, in children using the PubMed databases. In addition, our own experience with ovarian cryopreservation in children was evaluated and compared with the literature.


RESULTS
Analysis of the literature and six published series on ovarian cryopreservation in children, as well as our own series of 58 cases, show that there is no reason to doubt its efficacy in this young population. However, no consensus has yet been reached on the indications for the technique. Indeed, with existing models, the real risk of POF may be over- or underestimated.


CONCLUSIONS
Our review suggests that ovarian cortex cryopreservation is feasible and as safe as comparable operative procedures in children. Although no births have yet resulted from freeze-thawing of prepubertal ovarian cortex, the results of this approach in adults are encouraging. However, the absence of consensus on the indications for fertility preservation, as well as the optimal timing and quantity of ovarian cortex for cryopreservation, should be taken into consideration when discussing fertility issues with girls at risk of POF and their parents.
Jadoul
Pascale
P
Department of Gynecology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Avenue Hippocrate 10, Brussels 1200, Belgium.
Dolmans
Marie-Madeleine
MM
Donnez
Jacques
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D005260:Female; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000628:therapy; D009369:Neoplasms / Q000150:complications; D010053:Ovary; D016649:Primary Ovarian Insufficiency / Q000209:etiology / Q000517:prevention & control; D011878:Radiotherapy / Q000009:adverse effects; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D018570:Risk Assessment; D014021:Tissue Preservation