Journal: Facts, views & vision in ObGyn
This publication is a narrative overview of current and emerging strategies in fertility preservation and how they fit into modern survivorship care.
Key points:
- Scope of fertility preservation
Initially rooted in oncology, fertility preservation now spans medical, social (e.g., elective “social freezing”), and technological domains, reflecting a shift from focusing solely on survival to emphasizing long-term quality of life. - Surgical approaches
Fertility-sparing surgery and ovarian transposition can protect reproductive potential while maintaining oncologic safety in selected patients. - Cryopreservation advances
Transition from slow-freezing to vitrification has made oocyte and embryo cryopreservation the gold-standard, with outcomes comparable to fresh cycles. - “Social freezing” and ethics
Use of elective oocyte freezing for non-medical reasons raises complex issues around counselling quality, age-related expectations, outcome realism, and equitable access. - Psychosocial dimensions
Emotional distress around infertility risk is common. Interventions such as mindfulness and structured counselling improve mental health and coping, even if they do not change pregnancy rates. - Emerging clinical options
Ovarian tissue cryopreservation enables FP in patients who cannot undergo stimulation (e.g., urgent cancer therapy), with early clinical successes. Immature testicular tissue banking offers possibilities for prepubertal boys, though it remains largely experimental. Uterus transplantation has become a first-line fertility-restoring option for women without a uterus, including after hysterectomy for cervical cancer. - Future directions and regenerative medicine
Investigational strategies include stem-cell–based approaches, 3D bioprinting of genital tissues, tissue engineering, and artificial uterus systems. These advances demand robust ethical, legal, and safety frameworks before broader clinical integration. - Overall message
Fertility preservation is a rapidly evolving, multidisciplinary field involving oncology, reproductive medicine, gynaecology, transplantation surgery, psychology, and laboratory science. Its development is driven not only by technological progress but also by a strong emphasis on patient autonomy, equity, and long-term survivorship outcomes.