ABSTRACT

Early detection and advanced treatment strategies in cancer have improved survival outcomes, leading to an increased interest for fertility preservation. Starting with the first description of the successful restoration of ovarian function after transplantation of previously cryopreserved ovarian cortical pieces, the field of fertility preservation entered into an accelerated phase. Once the cancer community and the patients took notice of the possibility of successfully and safely preserving fertility, fertility preservation became an increasingly important part of cancer care with attention to the improvement of post-survival quality of life. While embryo or oocyte cryopreservation can be offered to those individuals who have sufficient time for ovarian stimulation before chemotherapy, a sufficient time period is not available to all cancer patients. Moreover, especially in prepubertal children, ovarian stimulation is not feasible. When such limitations exist and when there is also the desire for the preservation of endocrine function, ovarian cryopreservation and transplantation stands out among the other techniques. However, the major limitation of ovarian transplantation is the follicle loss of at least two-thirds due to the initial ischemia while revascularization occurs. If these losses can be prevented, the ovarian transplant procedure can become the most preferred fertility preservation procedure in many cases. For this reason, we attempted to improve the orthotopic ovarian transplantation technique with the utility of a human decellularized extracellular tissue matrix scaffold, robot-assisted minimally invasive surgery, and perioperative pharmacological support.