University of Florida College of Medicine, Gainesville, FL, USA.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA.
Reprod Sci. 2021 Dec;28(12):3291-3302. doi: 10.1007/s43032-021-00591-6. Epub 2021 May 3.
After cancer treatment, female survivors often develop ovarian insufficiency or failure. Oocyte and embryo freezing are well-established fertility preservation options, but cannot be applied in pre-pubescent girls, in women with hormone-sensitive malignancies, or when gonadotoxic treatment cannot be delayed. Although ovarian tissue cryopreservation (OTC) has been used to restore fertility and endocrine function, the relative efficacy of its two major protocols, slow freezing and vitrification, remains controversial. This literature review evaluates clinical and lab-based studies published between January 2012 and June 2020 to determine whether vitrification, the optimal technique for oocyte and embryo cryopreservation, preserves ovarian tissue more effectively than slow freezing. Due to limited clinical data involving ovarian tissue vitrification, most clinical studies focus on slow freezing. Only 9 biochemical studies that directly compare the effects of slow freezing and vitrification of human ovarian tissue were noted. Most studies report no significant difference in follicular morphology and distribution between cryopreservation methods, but these findings must be interpreted in the context of high methodological variability. Discrepant findings regarding the effects of cryopreservation method on follicle viability, gene expression, and hormone production require further evaluation. Early clinical outcomes appear favorable for vitrification, but additional studies and longer term follow-up are needed to establish its efficacy. Sharing data through national or international registries would expedite this analysis. However, even if research corroborates conclusions of no clinical or biochemical difference between cryopreservation methods, the decreased costs and increased efficiency associated with vitrification make this method more accessible and cost-effective.
癌症治疗后，女性幸存者常出现卵巢功能不全或衰竭。卵母细胞和胚胎冷冻是成熟的生育力保存选择，但不能应用于青春期前的女孩、患有激素敏感性恶性肿瘤的妇女，或当性腺毒性治疗不能延迟时。虽然卵巢组织冷冻保存（OTC）已被用于恢复生育力和内分泌功能，但两种主要方案（慢速冷冻和玻璃化）的相对疗效仍存在争议。本文献综述评估了 2012 年 1 月至 2020 年 6 月期间发表的临床和实验室研究，以确定卵母细胞和胚胎冷冻保存的最佳技术玻璃化是否比慢速冷冻更有效地保存卵巢组织。由于涉及卵巢组织玻璃化的临床数据有限，大多数临床研究集中在慢速冷冻上。仅注意到 9 项直接比较人卵巢组织慢速冷冻和玻璃化效果的生化研究。大多数研究报告称冷冻保存方法对卵泡形态和分布无显著差异，但必须在高方法学变异性的背景下解释这些发现。关于冷冻保存方法对卵泡活力、基因表达和激素产生的影响存在不一致的发现，需要进一步评估。早期临床结果对玻璃化有利，但需要进一步的研究和更长时间的随访来确定其疗效。通过国家或国际登记处共享数据将加速这一分析。然而，即使研究证实冷冻保存方法在临床或生化方面无差异，玻璃化降低成本和提高效率使这种方法更易于获得且更具成本效益。
