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Fertility preservation is now recognized as the most essential quality of life issue in young cancer survivors. This chapter discusses three urgent and critical problems involved with ovarian tissue cryopreservation and transplantation (cryoin-jury, ischemic tissue damage, cancer cell transmission). The risk of cancer cell transmission is a serious safety issue related to ovarian autotransplantation in cancer patient. There are three strategies, at least in theory, to mature follicles in frozen stored ovarian tissue: autotransplantation; xenotransplantation; and in-vitro culture. Recently, significant progress has been made in immature follicle culture techniques. As an alternative to ovarian tissue transplantation, whole ovary transplantation has been explored. In theory, whole intact ovary transplantation with vascular anastomosis can restore the full function of the ovary. The main challenge of whole ovary transplantation for fertility preservation is the development of effective cryotechnology for the whole organ.
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.
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