Abstract
In current years, ovarian tissue cryopreservation (OTC) and transplantation is gaining ground as a successful method of preserving fertility in young women with primarily cancer diseases, hereby giving them a chance of becoming biological mothers later on. However, OTC preserves more than just the reproductive potential; it restores the ovarian endocrine function and thus the entire female reproductive cycle with natural levels of essential hormones. In a female population with an increased prevalence in the loss of ovarian function due to induced primary ovarian insufficiency (POI) and aging, there is now, a need to develop new treatments and provide new opportunities to utilize the enormous surplus of follicles that most females are born with and overcome major health issues associated with the lack of ovarian hormones. Cell/tissue-based hormone replacement therapy (cHRT) by the use of stored ovarian tissue could be one such option comprising both induction of puberty in prepubertal POI girls, treatment of POI and premature menopause, and as primary prevention at the onset of menopause. In the current review, we explore known and entirely new applications for the potential utilization of OTC including cHRT, social freezing, culture of immature oocytes, and a modern ovarian resection for women with polycystic ovaries, and discuss the indications hereof.
Highlights
The follicle constitutes the functional unit of the ovary and produces steroids and peptide hormones to regulate the female reproductive cycle
By isolating the cortical region, containing 90% of the follicular reserve, human ovarian tissue has been successfully cryopreserved for fertility preservation in young women with cancer diseases for over two ovarian tissue cryopreservation (OTC)-More Than Just Fertility Preservation decades
The steroidogenic capacity and endocrine function of the tissue could potentially expand the utilization of OTC and the ovarian reserve to other beneficial applications throughout the female lifespan and several indications beyond cancer
Summary
The follicle constitutes the functional unit of the ovary and produces steroids and peptide hormones to regulate the female reproductive cycle. CHRT in the form of stored ovarian tissue or ovarian cell constructs [41, 48, 49] could potentially be used at the onset of natural or induced menopause as an ideal time to institute preventative strategies that could potentially increase the quality and length of women’s lives This is again technical possible but not proven in a clinical setting with women in this age group, and it can be argued that pHRT should be preferred in all cases as it is the cheapest and simplest way to provide hormones, and no real evidence for the superiority of physiological hormone levels exists. It should be highlighted that age is the most limiting and critical factor for both methods, and the success rate always depends hereof, which means that the issue with low ovarian reserve will apply for both methods, and low return rates are probably an inevitable factor in this group of women
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