Ovarian tissue cryopreservation in prepubertal girls: a systematic review of indications, outcomes, and clinical practice.

BACKGROUND

Ovarian tissue cryopreservation (OTC) is the only fertility-preservation option available for prepubertal girls at risk of premature ovarian insufficiency (POI). While its use is well established in adults, the experience is more limited in children.

METHODS

This systematic review was conducted according to PRISMA 2020 guidelines (PROSPERO CRD420251158063). PubMed, Scopus, Embase, and Web of Science were searched through July 2025 for studies investigating OTC and subsequent ovarian tissue transplantation (OTT) in prepubertal girls (≤12 years). Forty-five studies met inclusion criteria, including case reports, case series, and cohort studies.

RESULTS

Endocrine recovery occurred in all documented OTT cases, with few reported pregnancies - both spontaneous and ART-assisted - and no reported disease relapses. Surgical approaches varied widely, particularly regarding ovarian tissue harvesting (biopsy vs. unilateral oophorectomy) and the use of energy devices. Of the GV oocytesobtained from harvested ovarian cortex, in-vitro maturation (IVM) rates ranged from 15% to 38% and appeared age-dependent; one study showed improved outcomes after gonadotropin priming. In Turner syndrome, follicular density showed high variability and frequent follicular abnormalities, and no OTTs were reported. Ethical analyses emphasized parental decision-making and highlighted the need to involve older children in assent discussions.

CONCLUSIONS

Prepubertal OTC appears feasible and capable of restoring ovarian function after OTT, although current experience remains limited. Available data suggest reassuring oncologic safety, but further confirmation across malignancy types is required. OTC in prepubertal patients should therefore be confined to specialized programs, supported by multidisciplinary counseling and long-term follow-up.