**5. Conclusion**

220 Topics in Cancer Survivorship

quiescent follicles (Dath et al., 2010). However, Sonmezer reported an asynchrony between

**SLICES or WHOLE** 

25 Frozen/thawed Slices Orthotopic: ovarian

24 Frozen/thawed Slices Orthotopic (+

**REIMPLANTATION** 

fossa peritoneum

heterotopic)

**OUTCOME**

Spontaneous pregnancy: **live birth**

pregnancy: **live birth**

stimulation - IVF: **live birth**

Spontaneous pregnancy: **live birth in 2007 live birth in 2009**

stimulation - IVF: **live birth**

stimulation - IVF: **1 live birth.**  Spontaneous pregnancy: **1 live birth**

pregnancies **B -live birth**

stimulation, IVF: **2 live births** (twins)

Spontaneous pregnancy: **live birth**

**+ 1 live birth**

**SIDE**

17 Frozen/thawed Slices Orthotopic: ovary Spontaneous

28 Frozen/thawed Slices Orthotopic: ovary Mild ovarian

27 Frozen/thawed Slices Orthotopic: ovary Ovarian

27 Frozen/thawed Slices Orthotopic: ovary Mild ovarian

20 Frozen/thawed Slices Orthotopic A- Ongoing

27 Frozen/thawed Slices Orthotopic IVF: **live birth**

19 Frozen/thawed Slices Orthotopic IVF: **live birth**

few strips deposited in the peritoneal window

20 Frozen/thawed Slices Orthotopic: ovary and

USA 24 Frozen/thawed Slices Orthotopic **1 live birth** 

Spain Breast cancer 36 Frozen/thawed Slices Orthotopic Ovarian

Table 1. Live births after frozen/thawed orthotopic transplantation of human ovarian tissue. In conclusion, xenotransplantation should be carefully considered in its human clinical

application because of the risk of cross-species retroviral infection.

**FRESH or CRYO-PRESERVED** 

oocytes and granulosa cell development (Sonmezer & Oktay, 2010).

**at cryo**

**WHERE DIAGNOSIS AGE**

Hodgkin's lymphoma

mic tumour

Hodgkin's lymphoma

Hodgkin's lymphoma

lymphoma

sarcoma

Hodgkin's lymphoma

Belgium Stage IV

Belgium Neuroectoder

Israel Non

Belgium Stage IV

Denmark Hodgkin's

Denmark Ewing

USA Stage IIIb

France Microscopic polyangiitis

Israel Thalassemia major

France Homozygous sicule cell anemia

**FIRST AUTHOR YEAR**

**Donnez, 2004** 

**Donnez, 2011-a**

**Meirow**, **2005, 2007**

**Demeester e, 2007, 2010**

**Andersen, 2008** 

**Andersen, 2008; Ernst, 2010** 

**A- Silber, 2010 B- (Donnez, 2011 b)**

**Silber, 2010** 

**Piver, 2009**

**Sanchez-Serrano, 2010**

**Revel, 2011**

**Roux, 2010** 

As reported by Maltaris it is important to assess the 'ovarian reserve' that is the available pool of primordial follicles in the ovary and is a major determinant of female fertility potential. This information is important for a correct strategy of fertility preservation before cancer treatment. In general, ovarian reserve tests are either biochemical or biophysical (Maltaris et al., 2006), but new methods are required.

In conclusion, a common goal of life-saving methods must be to protect the fertility of young women to this aim it is important to form a closely collaborative team comprising gynaecologists, surgeons, oncologists, haematologists, biologists and psychologists. Specifically, it is important that the oncologist gives an assessment of the degree of ovarian damage in order to decide how much ovarian tissue to retrieve and store.

It is known that for each malignant disease only few protocols are commonly used, so it is possible to analyse the risk of ovarian failure. Meirow reported that the ovarian failure rate was 50% for breast cancer, 44% for non-Hodgkin's lymphoma, and 32% for Hodgkin's disease (Meirow & Nugent, 2001).

Before proceeding to cryopreserve ovarian tissue, it is important to identify a series of tests for morphological analyses (such as staining with hematoxylin and eosin for observation by an optical microscope, or a more thorough evaluation of cell components by electron microscopy), for functional analyses (such as immunohistochemistry), or for viability analyses (such as trypan blue); in order to assess the degree of overall tissue preservation with the procedure adopted in the laboratory.

In addition, it is also important to put an age limit to the preservation of ovarian tissue. The patient can use it only after cancer remission, therefore not before few years, so the cryopreservation of ovarian tissue of a patient older than 38 years old may be a useless procedure but could give psychological support to women. In any case, patients should be properly informed about the real possibility of recovering fertility and be able to get pregnant.

In conclusion, we agree with Donnez that ovarian tissue cryopreservation should be offered before anticancer treatments in all cases where there is a high risk of premature ovarian failure and where emergency in vitro fertilization is not possible (Donnez et al., 2011-c).

If the dogma of reproductive biology is that of a finite number of follicles in the ovary which, moreover, undergo atresia during reproductive life, all procedures to preserve fertility should be carried out before acting on the ovary with drugs, therapies, surgery or potentially toxic treatments. Therefore, live births after cryoprserved ovarian tissue trasnplantation opened up new chapter in the field of infertility preservation.
