Delaying Reproductive Aging by Ovarian Tissue Cryopreservation and Transplantation: Is it Prime Time?

Ovarian tissue cryopreservation and autotransplantation can restore ovarian endocrine function and fertility and recently were changed from experimental to fertility preservation procedures for medical indications by the American Society of Reproductive Medicine. Such advances have resulted in discussions around the utility of ovarian cryopreservation in healthy women to preserve fertility and delay menopause or as a hormone replacement approach. Such ‘elective’ use of ovarian tissue cryopreservation requires a risk–benefit assessment. Here, we review evidence for and against the utility of ovarian tissue harvesting in healthy women, scrutinize recent and needed advances to enhance the feasibility of such an approach, and provide practice and future research guidelines. The successful use of ovarian tissue cryopreservation and autotransplantation in patients with cancer resulted in their recent change from experimental to fertility preservation procedures, prompting calls for their use to postpone childbearing and/or delay menopause in healthy women.Current experience with elective ovarian tissue freezing is limited and no direct risk–benefit analyses are available.Evaluation of the impact of ovarian tissue harvesting on age at natural menopause is necessary for a risk–benefit assessment for this procedure in healthy women.The large primordial follicle reserve losses during revascularization shortens the longevity of ovarian transplants, a limitation for its use for postponing age-induced infertility or menopause.Advances in ovarian freezing, thawing, transplantation techniques, and neovascularizing agents may render elective ovarian tissue freezing more feasible in the future.