Fertility preservation before sterilizing treatment: cryopreservation of both ovaries to restore endocrine and reproductive functions

Ovarian cortex cryopreservation is now a validated fertility preservation technique. Autotransplantation of this tissue allows restoration of ovarian hormone function in more than 90% of patients, and birth of at least one child in 30% of transplanted women. In the case of very highly gonadotoxic treatments, it is recommended that ovarian cortex be cryopreserved as first-line therapy to safeguard future fertility. However, the ovary left in place runs a very high risk of being significantly altered. This raises the question of harvesting both ovaries, looking to restore fertility as well as endocrine function. Indeed, hormone balance in these cancer survivors may be recovered naturally for their entire lifetime. Autotransplantation could also be performed to restore hormone function in women with no wish to have children, with the sole purpose of improving their quality of life. Ethical and legal challenges exist and are discussed in this paper, but they do not constitute an argument against it. Clinical trials investigating this strategy are clearly needed, but this approach truly offers women the chance of having both endocrine and reproductive functions restored and maintained throughout their entire life.