Protection of ovarian tissue from radiotherapy

Advances researches in the diagnosis and treatment of childhood, adolescent and adult cancer havegreatly increased the life expectancy of premenopausal women with cancer. However, one of the serious sideeffects of these treatments is the risk of damage to fertility. The ovaries are very sensitive to cytotoxic andradiotherapeutic treatment. The only established method of fertility preservation is embryo cryopreservationaccording to the Ethics Committee of the American Society for Reproductive Medicine (2005), but this optionrequires the patient to be of pubertal age, have a partner or use donor sperm, and be able to undergo a cycleof ovarian stimulation, which is not possible when the radiotherapy has to be initiated immediately or whenstimulation is contraindicated according to the type of cancer. For patients who need immediate radiotherapy,cryopreservation of ovarian tissue is the only possible alternative. This manuscript reports the different techniquesof cryopreservation and the results of transplantation of cryopreserved ovarian tissue. The currenttechniques allow cryopreservation of human ovarian fragments for a long time with good follicular survival rateafter thawing. Numerous studies ultimately in this field have demonstrated to improve the survival rate of theoocytes and cryopreserved follicles. Moreover this manuscript includes a case of a 17-year-old girl who hadto undergo pelvic irradiation for non-Hodgkin’s lymphoma and the laparoscopic treatment to preserve the fertility(Fig. 2, Ref. 47).