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Review
. 2023 Oct 17;11(20):2748.
doi: 10.3390/healthcare11202748.

Innovative Strategies for Fertility Preservation in Female Cancer Survivors: New Hope from Artificial Ovary Construction and Stem Cell-Derived Neo-Folliculogenesis

Stefano Canosa  1 , Alberto Revelli  1   2 , Gianluca Gennarelli  1   3 , Gennaro Cormio  4   5 , Vera Loizzi  4   5 , Francesca Arezzo  6 , Easter Anna Petracca  4 , Andrea Roberto Carosso  3 , Danilo Cimadomo  7 , Laura Rienzi  7   8 , Alberto Vaiarelli  7 , Filippo Maria Ubaldi  7 , Erica Silvestris  4
Affiliations
Review

Innovative Strategies for Fertility Preservation in Female Cancer Survivors: New Hope from Artificial Ovary Construction and Stem Cell-Derived Neo-Folliculogenesis

Stefano Canosa et al. Healthcare (Basel). .

Abstract

Recent advances in anticancer treatment have significantly improved the survival rate of young females; unfortunately, in about one third of cancer survivors the risk of ovarian insufficiency and infertility is still quite relevant. As the possibility of becoming a mother after recovery from a juvenile cancer is an important part of the quality of life, several procedures to preserve fertility have been developed: ovarian surgical transposition, induction of ovarian quiescence by gonadotropin-releasing hormone agonists (GnRH-a) treatment, and oocyte and/or ovarian cortical tissue cryopreservation. Ovarian tissue cryostorage and allografting is a valuable technique that applies even to prepubertal girls; however, some patients cannot benefit from it due to the high risk of reintroducing cancer cells during allograft in cases of ovary-metastasizing neoplasias, such as leukemias or NH lymphomas. Innovative techniques are now under investigation, as in the construction of an artificial ovary made of isolated follicles inserted into an artificial matrix scaffold, and the use of stem cells, including ovarian stem cells (OSCs), to obtain neo-folliculogenesis and the development of fertilizable oocytes from the exhausted ovarian tissue. This review synthesizes and discusses these innovative techniques, which potentially represent interesting strategies in oncofertility programs and a new hope for young female cancer survivors.

Keywords: artificial ovary; cancer survivor; cryopreservation; fertility preservation; oncofertility; stem cells.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Artificial ovary construction. The artificial ovary aims to restore reproductive and/or endocrine function of ovaries. Ovarian tissue or entire ovaries are retrieved and cryopreserved. Isolated follicles are obtained and cultured in a three-dimensional scaffold (the so-called artificial ovary) that permits follicles survival and development. To increase artificial ovary efficiency, growth factors, stromal and endothelial cells as well as supporting cells can be also included into the scaffold to permit hormone production and enhance vascularization.
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This research received no external funding.