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  • Print publication year: 2008
  • Online publication date: December 2009

7 - FERTILITY

Summary

The field of reproductive medicine is evolving rapidly. We are living in an era in which what was seemingly impossible a decade ago is being made possible, and century-old dogmas are being challenged. Thanks to new cryopreservation technologies, infertility and premature ovarian failure, especially when induced by medical treatments, are no longer unavoidable consequences. Whereas success with oocyte cryopreservation is gradually approaching acceptable levels for use in patients who face the risk of ovarian failure due to medical treatments or to create “egg banks” for oocyte donation, ovarian tissue cryopreservation and transplantation promise to be a way to reverse menopause and restore fertility. Yet, the recently proposed possibility of the presence of germ stem cells in human bone marrow is even more intriguing. Whereas bone marrow and peripheral blood transplants result in repopulation of chemotherapy-treated ovaries with primordial follicles in rodents, germ stem cell markers are already shown in human bone marrow and peripheral blood. According to this theory, the ovaries provide signals to the germ stem cells residing in the bone marrow and recruit new follicles via the bloodstream “on demand.” Although shocking and contrary to the preexisting dogma that the ovarian reserve is predetermined before birth, this hypothesis is not without supporting evidence in humans and nonhuman primates, as illustrated by the following case study.