title: Updates in preserving reproductive potential of prepubertal girls with cancer: Systematic review.
abstract: BACKGROUND
  With increasing numbers of adult female survivors of childhood cancers due to advances in early diagnosis and treatment, the issue of preserving the reproductive potential of prepubertal girls undergoing gonadotoxic treatments has gained greater attention.
  
  
  METHODS
  According to PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English throughout the past 15 years to explore the significant updates in preserving the reproductive potential of prepubertal girls with cancer.
  
  
  RESULTS
  The two established fertility preservation options, embryo freezing and egg freezing, cannot be offered routinely to prepubertal girls as these options necessitate prior ovarian stimulation and subsequent mature oocytes retrieval that are contraindicated or infeasible before puberty. Therefore, the most suitable fertility preservation options to prepubertal girls are (1) ovarian tissue freezing and autotransplantation, (2) in vitro maturation, and (3) ovarian protection techniques. In this review, we discuss in detail those options as well as their success rates, advantages, disadvantages and future directions. We also suggest a new integrated strategy to preserve the reproductive potential of prepubertal girls with cancer.
  
  
  CONCLUSIONS
  Although experimental, ovarian tissue slow freezing and orthotopic autotransplantation may be the most feasible option to preserve the reproductive potential of prepubertal girls with cancer. However, this technique has two major and serious disadvantages: (1) the risk of reintroducing malignant cells, and (2) the relatively short lifespan of ovarian tissue transplants. Several medical and ethical considerations should be taken into account before applying this technique to prepubertal girls with cancer.
authors.affiliation: Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany; Department of Reproductive Medicine, Medical Division, National Research Center of Egypt, Egypt. Electronic address: eaims_gm@yahoo.com.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Salama
authors.affiliation: Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany. Electronic address: vladimir.isachenko@googlemail.com.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Isachenko
authors.affiliation: Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany. Electronic address: e.isachenko@yahoo.de.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Isachenko
authors.affiliation: Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany. Electronic address: gohar.rahimi@uk-koeln.de.
authors.forename: Gohar
authors.initials: G
authors.lastname: Rahimi
authors.affiliation: Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany. Electronic address: peter.mallmann@uk-koeln.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Mallmann
mesh_terms: D000818:Animals; D002648:Child; D015925:Cryopreservation; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D005306:Fertilization; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy; D017741:Survivors
keywords: Autotransplantation; Cancer; Cryopreservation; Female fertility preservation; In vitro maturation; Oncofertility; Prepubertal girls