Fertility Preservation in Pre-Pubertal and Pubertal Cancer Female Patients

Abstract

Introduction. Ovarian tissue cryopreservation​​ is an important method for fertility preservation in pre- and pubertal patients. It offers several advantages, including the avoidance of ovulation stimulation and no delay in initiating chemotherapy. Recent advancements in laparoscopic harvesting, storage, and autotransplantation of ovarian cortex tissue have resulted in an estimated live birth rate of ​​35–40%​​ in adult cancer patients. Although considered experimental until 2019, the technique has since led to the birth of over ​​200 children worldwide​​, solidifying its position as one of the primary fertility preservation methods. Currently, ​​laparoscopic ovarian tissue retrieval​​, ​​slow-freeze cryopreservation​​ before specialized treatment, and ​​post-recovery autotransplantation​​ of ovarian (cortical) tissue may represent the ​​gold standard​​ for fertility preservation in prepubertal girls. However, ​​Russia​​ has yet to establish a standardized implementation protocol, including selection criteria, patient recruitment guidelines, and legal support for children and their parents (or guardians). Also, the country lacks a ​​centralized cryobank​​ for storing biological material.

Materials and Methods. The clinical study protocol was initiated at the N.N.​​Petrov National Medical Research Center of Oncology​​ (Ministry of Health of Russia) and approved by the ​​Local Ethics Committee (Protocol No. 16, dated 21.03.2023).​ This ​​single-center, randomized study​​ investigates fertility preservation methods in ​​pre- and pubertal girls​​ with cancer. Out of ​​120 screened patients​​, ​​50 were randomized​​ for participation. The study population consists of ​​girls under 18 years of age​​ diagnosed with cancer.

Conclusion. Several ​​effective yet still experimental​​ methods exist for fertility preservation in children. For girls facing ​​highly gonadotoxic​​ antitumor therapy, ​​ovarian tissue cryopreservation​​ may be considered before treatment. This involves surgically removing and freezing ovarian tissue for future ​​reimplantation​​ after recovery. This method has disadvantages because it is invasive and requires general anesthesia, as well as advantages, as it can be performed as early as one year of age. An ​​alternative approach​​, feasible ​​one year after puberty​​, involves ​​ovarian stimulation followed by follicular puncture​​ for ​​oocyte cryopreservation​​. While ​​less invasive​​, this method offers ​​more limited reproductive potential​​ compared to ovarian tissue preservation.

Further studies are essential to evaluate the ​​relevance and efficacy​​ of these techniques, ensuring optimal fertility preservation strategies for pediatric patients.