- •Ovarian tissue cryopreservation and transplantation (OTCT) is increasingly being used in young cancer patients for fertility restoration and the prevention of premature ovarian insufficiency.
- •Ovarian tissue cryopreservation and transplantation has recently been advocated as a method to delay menopause.
- •Ovarian tissue cryopreservation and transplantation to delay menopause may need to be repeated several times to achieve long-term restoration of ovarian function.
- •It is not clear whether ovarian grafts result in a normal steroid pulsatile secretion, similar to that present during reproductive years.
- •It is not known whether the need to restore ovarian activity appears earlier in women who undergo OTCT to delay menopause.
- •There is no evidence to suggest that OTCT is superior to hormone replacement therapy in terms of both efficacy and safety.
Ovarian tissue cryopreservation and transplantation (OTCT) is increasingly being used in young cancer patients for fertility restoration and prevention of premature ovarian insufficiency (POI) and has recently been advocated as a method to delay menopause. This is accomplished by cryopreserving ovarian tissue that is excised laparoscopically in thin pieces at a young age. Cryopreserved tissue will be transplanted at menopause, when ovarian function is no longer present. Transplantation may need to be repeated several times to achieve long-term restoration of ovarian function. However, it is unknown whether ovarian grafts result in a normal steroid pulsatile secretion, similar to that present during reproductive years. In addition, it is not known whether the need to restore ovarian activity appears earlier in women who undergo OTCT to delay menopause, although indirect data suggest that this is likely to be true. Until today, no cohort or comparative studies evaluating OTCT as a potential alternative to hormone replacement therapy (HRT) have been published and, thus, there is no evidence to suggest that OTCT is superior to HRT in terms of both efficacy and safety. Given the availability of alternative, established treatments for managing menopausal symptoms, as well as the multiple unanswered questions regarding the method, it is imperative that, before OTCT is regarded as a mainstream technique for management of menopausal symptoms, further evaluation and clinical investigation are undertaken.
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- Clinical Guidelines, Menopause: diagnosis and management.National Institute for Health and Care Excellence, London2019
- Natural hormone replacement therapy with a functioning ovary after the menopause: dream or reality?.Reprod Biomed Online. 2018; 37: 359-366
- The ovary: from conception to death.Fertil Steril. 2017; 108: 594-595
- Ovary freezing offers a drug-free way to tame menopause.New Scientist Health, 2015
- Cryopreservation of Ovarian Tissue: Opportunities Beyond Fertility Preservation and a Positive View Into the Future.Front Endocrinol (Lausanne). 2018; 9: 347
- Human ovarian reserve from conception to the menopause.PLoS One. 2010; 5: e8772
- Cryopreservation and transplantation of ovarian tissue exclusively to postpone menopause: technically possible but endocrinologically doubtful.Reprod Biomed Online. 2015; 31: 718-721
- FERTILITY PRESERVATION: Freezing of ovarian tissue and clinical opportunities.Reproduction. 2019; 158: F27-F34
- What the future holds for women after menopause: where we have been, where we are, and where we want to go.Climacteric. 2014; 17: 12-17
- Long-term ovarian function evaluation after autografting by implantation with fresh and frozen-thawed human ovarian tissue.J Clin Endocrinol Metab. 2001; 86: 4489-4494
- Ovarian cortical transplantation may be an alternative to hormone therapy in patients with early climacterium.Fertil Steril. 2005; 84: 1509
- Assessment of long term endocrine function after transplantation of frozen-thawed human ovarian tissue to the heterotopic site: 10 year longitudinal follow-up study.J Assist Reprod Genet. 2012; 29: 489-493
- Evaluation of the ovarian reserve in women transplanted with frozen and thawed ovarian cortical tissue.Fertil Steril. 2012; 97 (1394-8 e1)
- Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates.Hum Reprod. 2016; 31: 2031-2041
- Efficacy of ovarian tissue cryopreservation for fertility preservation: lessons learned from 545 cases.Hum Reprod. 2017; 32: 1046-1054
- Increasing survival of the graft: the way forward in ovarian tissue transplantation.Reprod Biomed Online. 2015; 30: 4-5
- Improvement in the quality of heterotopic allotransplanted mouse ovarian tissues with basic fibroblast growth factor and fibrin hydrogel.Hum Reprod. 2013; 28: 2784-2793
- Royal College of Obstetricians and Gynaecologists, Preventing Entry-related Gynaecological Laparoscopic Injuries, Green-top Guideline No. 49.RCOG, London2008
- Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women.Reprod Biomed Online. 2015; 31: 605-612
- Cryostorage and retransplantation of ovarian tissue as an infertility treatment.Best Pract Res Clin Endocrinol Metab. 2019; 33: 89-102
- International Society for Fertility Preservation, Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives.Fertil Steril. 2017; 108 (e11): 407-415
- Factors associated with premature ovarian failure, early menopause and earlier onset of menopause in Japanese women.Maturitas. 2012; 72: 249-255
- The association of hysterectomy and menopause: a prospective cohort study.BJOG. 2005; 112: 956-962
- Is unilateral oophorectomy associated with age at menopause? A population study (the HUNT2 Survey).Hum Reprod. 2014; 29: 835-841
- The influence of unilateral oophorectomy on the age of menopause.Climacteric. 2017; 20: 540-544
- The impact of unilateral oophorectomy on ovarian reserve in assisted reproduction: a systematic review and meta-analysis.BJOG. 2018; 125: 26-35
- Orthotopic and heterotopic ovarian tissue transplantation.Best Pract Res Clin Obstet Gynaecol. 2010; 24: 113-126
- Menopausal Hormone Therapy: Understanding Long-term Risks and Benefits.Jama. 2017; 318: 911-913
- I. Writing Group for the Women’s Health Initiative, Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial.JAMA. 2002; 288: 321-333
- Maintaining postreproductive health: A care pathway from the European Menopause and Andropause Society (EMAS).Maturitas. 2016; 89: 63-72
- British Menopause Society consensus statement: The risks and benefits of HRT before and after a breast cancer diagnosis.Post Reprod Health. 2019; 25: 33-37
- The role of menopausal hormone therapy in women with or at risk of ovarian and breast cancers: Misconceptions and current directions.Cancer. 2019; 125: 499-514
- T. Ovarian Cancer Screening Trial Project, Breast cancer epidemiology according to recognized breast cancer risk factors in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial Cohort.BMC Cancer. 2009; 9: 84
- Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis.BJOG. 2019; 126: 330-339
Published online: July 22, 2020
Accepted: July 21, 2020
Received in revised form: July 15, 2020
Received: May 2, 2020
© 2020 Elsevier B.V. All rights reserved.