Table 1 Main techniques of fertility preservation

Ovarian cortex freezing

- for future orthotopic graft or

- in vitro follicular maturation if a graft is not possible because of the risk of re-introducing dormant cells

- can even be performed in an emergency

Oocyte cryopreservation after a conventional in vitro fertilization stimulation protocol

- specially indicated in young, single female patients (live birth rate: 1% to 2%)

- but time for stimulation needed before radio/chemotherapy

In vitro fertilization and embryo freezing

- currently the best preservation technique

- requires 3 weeks for the ovarian stimulation and thus will only be indicated if it is possible to postpone radio/chemotherapy.

Drug-based preservation with gonadotropin releasing hormone (GnRH) agonists.

- widely used

- easy to perform, even in an emergencuy context

Transposition of the ovaries prior to radiotherapy.

If the planned treatment is highly gonadotoxic, it is possible (and indeed advisable) to transpose one ovary and freeze the other.

Indications

Young girl

ovarian freezing only possible option

Pubertal girl and /or woman under the age of 40:

all of the above-listed techniques can be considered.

Single women,

oocyte cryopreservation and ovarian cortex freezing preferable