Keywords
in vitro follicle development
in vitro culture
How to Cite
Abstract
Study question: Is fertility restoration possible through in vitro follicle development of primordial follicles (PFs) contained in cryopreserved ovarian cortex in patients with contraindications for ovarian tissue autotransplantation? Summary answer: The in vitro follicle development technique from cryopreserved ovarian tissue emerges as a promising, still experimental, strategy for such patients. Although it still faces challenges, such as a low follicle viability rate and poor technique efficiency, its potential to generate mature oocytes has been demonstrated, requiring the optimization of culture conditions. What is already known: Antineoplastic treatments in prepubertal girls and childbearing-aged women cause gonadal damage, resulting in decreased fertility. Cryopreservation and autotransplantation of ovarian tissue are the only available fertility preservation options for prepubertal girls and patients who cannot delay treatment initiation. However, in certain cancer types like leukemia and Burkitt lymphoma, there is a risk of reintroducing hidden malignant cells into transplanted ovarian tissue. Patients in this category could benefit from the in vitro follicle development technique. This experimental procedure involves the in vitro growth of primordial follicles (PF) contained in the ovarian cortex, progressing to mature follicles with metaphase II (MII) oocytes. Study Design: The article presents a narrative review that compiles information on folliculogenesis, involved signaling pathways, various in vitro culture systems, strategies for optimizing in vitro follicle activation, and future research directions to enhance the technique. Main results: While the feasibility of the technique in human tissue has been demonstrated, limitations such as low follicle viability and poor technique efficiency persist. Further studies are needed to optimize culture conditions and improve the success rate of this approach. With ongoing optimization and continuous refinement, in vitro follicle development could eventually offer a valuable fertility restoration option in the clinical setting. Limitations: Although the in vitro follicle development technique shows great potential, it still presents challenges such as uncontrolled follicle activation, limited efficiency, and a lack of long-term evaluation of oocyte genetic stability.
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