Fertility preservation methods in the context of breast cancer treatment: real-life experience and prospects

The article discusses current methods for preserving fertility in women undergoing breast cancer (BC) treatment. It provides a detailed overview of contemporary breast cancer treatments and their impact on fertility. To prevent fertility loss, there are described key strategies such as oocyte, embryo, and ovarian tissue cryopreservation, as well as temporary suppression of ovarian function using gonadotropin-releasing hormone agonists. In addition, it analyzes factors such as lack of information, limited medical resources, and the need for immediate anticancer therapy initiation that hinder access to such methods. The importance of comprehensive patient support systems involving coordination among oncologists, reproductive specialists, and psychologists is emphasized. Special attention is paid to further development and improvement of existing methods aimed at reducing gonadotoxicity, as well as ongoing research to identify new safe and effective strategies. It is specifically stressed about importance of long-term monitoring of children born from preserved gametes and tissues to assess the safety and efficacy of such approaches. Integrating fertility preservation into the overall BC treatment strategy can markedly improve women's quality of life by increasing their chances of regaining reproductive function after completing primary treatment.

1. Merabishvili V.M., Semiglazov V.F., Komiakhov A.V. et al. The state of cancer care in Russia: breast cancer. Epidemiology and survival of patients. The impact of the SARS-CoV-2-beta-coronavirus epidemic (clinical and population study). [Sostoyanie onkologicheskoj pomoshchi v Rossii: rak molochnoj zhelezy. Epidemiologiya i vyzhivaemost' bol'nyh. Vliyanie epidemii beta-varianta koronavirusa SARS-CoV-2 (kliniko-populyacionnoe issledovanie)]. Opuholi zhenskoj reproduktivnoj sistemy. 2023;19(3):16–24. (In Russ.). https://doi.org/10.17650/1994-4098-2023-19-3-16-24.

2. Tjulandin S.A., Stenina M.B., Frolova M.A. Practical tools to facilitate the choice of adjuvant systemic therapy for resectable luminal HER2-negative breast cancer. [Prakticheskie instrumenty, oblegchayushchie vybor ad"yuvantnoj lekarstvennoj terapii u bol'nyh operabel'nym lyuminal'nym HER2-negativnym rakom molochnoj zhelezy]. Zlokachestvennye opuholi. 2024;14(2):51–7. (In Russ.). https://doi.org/10.18027/2224-5057-2024-003.

3. Pavlova V.I., Belaya Yu.A., Vorontsov A.Yu. et al. Results of research work Russian society of oncomammologists “The use of artificial intelligence for early detection of breast cancer”. [Rezul'taty nauchno-issledovatel'skoj raboty Rossijskogo obshchestva onkomammologov «Ispol'zovanie iskusstvennogo intellekta dlya rannego vyyavleniya raka molochnoj zhelezy»]. Opuholi zhenskoj reproduktivnoj sistemy. 2023;19(2):54–60. (In Russ.). https://doi.org/10.17650/1994-4098-2023-19-2-54-60.

4. Akhapkina E.S., Makieva M.I., Khokhlova S.V. et al. Health status of children born from mothers with breast cancer during pregnancy: a review of the literature. [Osobennosti sostoyaniya zdorov'ya detej, rozhdennyh u materej s rakom molochnoj zhelezy vo vremya beremennosti: obzor literatury]. Neonatologiya: novosti, mneniya, obuchenie. 2023;11(4):21–5. (In Russ.). https://doi.org/10.33029/2308-2402-2023-11-4-21-25.

5. Llarena N.C., Estevez S.L., Tucker S.L., Jeruss J.S. Impact of fertility concerns on tamoxifen initiation and persistence. J Natl Cancer Inst. 2015;107(10):djv202. https://doi.org/10.1093/jnci/djv202.

6. Oktay K., Harvey B.E., Partridge A.H. et al. Fertility preservation in patients with cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2018;36(19):1994–2001. https://doi.org/10.1200/JCO.2018.78.1914.

7. Vuković P., Kasum M., Raguž J. et al. Fertility preservation in young women with early-stage breast cancer. Acta Clin Croat. 2019;58(1):147–56. https://doi.org/10.20471/acc.2019.58.01.19.

8. Partridge A.H., Pagani O., Abulkhair O. et al. First international consensus guidelines for breast cancer in young women (BCY1). Breast. 2014;23(3):209–20. https://doi.org/10.1016/j.breast.2014.03.011.

9. Lambertini M., Del Mastro L., Pescio M.C. et al. Cancer and fertility preservation: international recommendations from an expert meeting. BMC Med. 2016;14:1. https://doi.org/10.1186/s12916-015-0545-7.

10. Perevodchikova N.I., Stenina M.B. Modern possibilities of individualization of drug therapy for breast cancer. [Sovremennye vozmozhnosti individualizacii lekarstvennoj terapii raka molochnoj zhelezy]. Rossijskij onkologicheskij zhurnal. 2016;21(1–2):18–25. (In Russ.). https://doi.org/10.18821/1028-9984-2015-21-1-18-25.

11. Vartanyan E.V., Dobrokhotova Yu.E., Devyatova E.A., Tsaturova K.A. Females’ fertility preservation in malignancies. [Sohranenie zhenskoj fertil'nosti pri onkologicheskih zabolevaniyah]. Problemy reprodukcii. 2020;26(4):68–76. (In Russ.). https://doi.org/10.17116/repro20202604168.

12. Castillo C., Camejo N. Impact of breast cancer treatments on fertility and the importance of timing for a fertility preservation intervention. Rev Senol Patol Mam. 2022;35(4):305–11. https://doi.org/10.1016/j.senol.2021.08.004.

13. Mauri D., Gazouli I., Zarkavelis G. et al. Chemotherapy associated ovarian failure. Front Endocrinol. 2020;11:572388. https://doi.org/10.3389/fendo.2020.572388.

14. Wang S., Pei L., Hu T. et al. Protective effect of goserelin on ovarian reserve during (neo)adjuvant chemotherapy in young breast cancer patients: a prospective cohort study in China. Hum Reprod. 2021;36(4):976–86. https://doi.org/10.1093/humrep/deaa349.

15. Blumenfeld Z. Fertility preservation in women with malignancy: future endeavors. Clin Med Insights Reprod Health. 2019;13:1179558119872490. https://doi.org/10.1177/1179558119872490.

16. Çelebi F., Ordu Ç., Ilgün S. et al. The effect of systemic chemotherapy on ovarian function: a prospective clinical trial. Eur J Breast Health. 2020;16(3):177–82. https://doi.org/10.5152/ejbh.2020.5114.

17. Zikiryakhodzhaev A.D., Novikova O.V., Rasskazova E.A. Possibilities for pregnancies and deliveries in succession to the treatment of breast cancer. [Vozmozhnost' beremennostej i rodov posle lecheniyaraka molochnoj zhelezy]. Arhiv akusherstva i ginekologii imeni V.F. Snegireva. 2017;4(3):149–53. (In Russ.). https://doi.org/10.18821/2313-8726-2017-4-3-149-153.

18. Belousov D.Yu., Cheberda A.E. Adjuvant hormone therapy in early-stage estrogen-positive breast cancer: a systematic review and network meta-analysis. [Ad"yuvantnaya gormonal'naya terapiya na rannej stadii estrogenpolozhitel'nogo raka molochnoj zhelezy: sistematicheskij obzor i setevoj metaanaliz]. Pacientoorientirovannaya medicina i farmaciya. 2023;1(2):75–84. (In Russ.). https://doi.org/10.37489/2949-1924-0017.

19. Imyanitov E.N. Evolution of systemic treatment for hormone-sensitive breast cancer: from sequential use of single agents to the upfront administration of drug combinations. [Evolyuciya sistemnogo lecheniya gormonozavisimogo raka molochnoj zhelezy: ot cheredovaniya preparatov k kombinirovannoj terapii]. Opuholi zhenskoj reproduktivnoj sistemy. 2016;12(2):46–51. (In Russ.). https://doi.org/10.17650/1994-4098-2016-12-2-46-51.

20. Tremont A., Lu J., Cole J.T. Endocrine therapy for early breast cancer: updated review. Ochsner J. 2017;17(4):405–11.

21. Nazarenko T.A., Parokonnaia A.A., Sharipova N.Yu. The use of aromatase inhibitors in art in women with breast cancer. [Primenenie ingibitorov aromatazy u bol'nyh rakom molochnoj zhelezy v programmah vspomogatel'nyh reproduktivnyh tekhnologij]. Problemy reprodukcii. 2012;(2):72–6. (In Russ.).

22. Savelyeva M.I., Golubenko E.O., Sozaeva Z.A. et al. Analysis of the complications of endocrine therapy with tamoxifen in breast cancer: clinical and pharmacogenetic aspects. Prospective pharmacogenetic cohort study. [Analiz oslozhnenij endokrinoterapii tamoksifenom pri rake molochnoj zhelezy: klinicheskie i farmakogeneticheskie aspekty]. Sovremennaya onkologiya. 2022;24(3):361–7. https://doi.org/10.26442/18151434.2022.3.201783.

23. Shandley L.M., Spencer J.B., Fothergill A. et al. Impact of tamoxifen therapy on fertility in breast cancer survivors. Fertil Steril. 2017;107(1):243–252.e5. https://doi.org/10.1016/j.fertnstert.2016.10.020.

24. Kim H.J., Noh W.C., Nam S.J. et al. Five-year changes in ovarian function restoration in premenopausal patients with breast cancer taking tamoxifen after chemotherapy: an ASTRRA study report. Eur J Cancer. 2021;151:190–200. https://doi.org/10.1016/j.ejca.2021.03.017.

25. Shevchenko Yu.A., Kuznetsova M.S., Khristin A.A. et al. Modern breast cancer therapy: from tamoxifen to T-cell engineering. [Sovremennaya terapiya raka molochnoj zhelezy: ot tamoksifena do T-kletochnoj inzhenerii]. Sibirskij onkologicheskij zhurnal. 2022;21(5):109–22. (In Russ.). https://doi.org/10.21294/1814-4861-2022-21-5-109-122.

26. Mehta P., Bothra S.J. PARP inhibitors in hereditary breast and ovarian cancer and other cancers: а review. Adv Genet. 2021;108:35–80. https://doi.org/10.1016/bs.adgen.2021.08.002.

27. Li J., Li Q., Zhang L. et al. Poly-ADP-ribose polymerase (PARP) inhibitors and ovarian function. Biomed Pharmacother. 2023;157:114028. https://doi.org/10.1016/j.biopha.2022.114028.

28. Artamonova E.V., Kovalenko E.I., Bolotina L.V. et al. CDK4/6 inhibitors in the treatment of metastatic breast cancer. Choosing optimal therapy for estrogen-receptor-positive HER2-negative metastatic breast cancer: analysis of doctors’ preferences (“Prometheus”) in Russia – first results of the survey. [Ingibitory CDK4/6 v terapii metastaticheskogo raka molochnoj zhelezy. Vybor optimal'noj terapii estrogen-receptor-polozhitel'nogo HER2-otricatel'nogo metastaticheskogo raka molochnoj zhelezy: obshcherossijskij analiz predpochtenij vrachej («Prometej») – pervye rezul'taty oprosa]. Opuholi zhenskoj reproduktivnoj sistemy. 2020;16(3):37–45. (In Russ.). https://doi.org/10.17650/1994-4098-2020-16-3-37-45.

29. Dong F., Meng T.G., Li J. et al. Inhibition of CDK4/6 kinases causes production of aneuploid oocytes by inactivating the spindle assembly checkpoint and accelerating first meiotic progression. Biochim Biophys Acta Mol Cell Res. 2021;1868(7):119044. https://doi.org/10.1016/j.bbamcr.2021.119044.

30. Scavone G., Ottonello S., Blondeaux E. et al. The role of cyclin-dependent kinases (CDK) 4/6 in the ovarian tissue and the possible effects of their exogenous inhibition. Cancers. 2023;15(20):4923. https://doi.org/10.3390/cancers15204923.

31. Catlin N.R., Bowman C.J., Engel S.M et al. Reproductive and developmental toxicity assessment of palbociclib, a CDK4/6 inhibitor, in Sprague-Dawley rats and New Zealand White rabbits. Reprod Toxicol. 2019;88:76–84. https://doi.org/10.1016/j.reprotox.2019.07.016.

32. Bolotina L.V. Strategy of drug therapy for metastatic breast cancer in the context of expanding the range of antitumor agents. [Strategiya lekarstvennoj terapii metastaticheskogo raka molochnoj zhelezy v usloviyah rasshireniya palitry protivoopuholevyh sredstv]. Voprosy onkologii. 2024;70(2):248–58. (In Russ.). https://doi.org/10.37469/0507-3758-2024-70-2-248-258.

33. Garutti M., Lambertini M., Puglisi F. Checkpoint inhibitors, fertility, pregnancy, and sexual life: a systematic review. ESMO Open. 2021;6(5):100276. https://doi.org/10.1016/j.esmoop.2021.100276.

34. Pigarova E.A., Shutova A.S., Dzeranova L.K. Correction of endocrine complications of oncoimmunotherapy. [Korrekciya endokrinnyh oslozhnenij onkoimmunoterapii]. Ozhirenie i metabolizm. 2022;19(4):418–30. (In Russ.) https://doi.org/10.14341/omet12828.

35. Nuralieva N.F., Troshina E.A., Melnichenko G.A. Lesions in endocrine glands as a complication of immunotherapy in the practice of oncologist. [Porazhenie zhelez vnutrennej sekrecii kak oslozhnenie immunoterapii v praktike onkologa]. Klinicheskaya i eksperimental'naya tireoidologiya. 2018;14(4):174–82. (In Russ.). https://doi.org/10.14341/ket9875.

36. Charmsaz S., Scott A.M., Boyd A.W. Targeted therapies in hematological malignancies using therapeutic monoclonal antibodies against Eph family receptors. Exp Hematol. 2017;54:31–9. https://doi.org/10.1016/j.exphem.2017.07.003.

37. Mandó P., Waisberg F., Pasquinelli R. et al. HER2-directed therapy in advanced breast cancer: benefits and risks. Onco Targets Ther. 2023;16:115–32. https://doi.org/10.2147/OTT.S335934.

38. Artamonova E.V., Lubennikova E.V. Optimal choice of neoadjuvant therapy for HER2-positive breast cancer. Analysis of doctors’ preferences in Russian Federation. [Optimal'nyj vybor neoad"yuvantnoj terapii HER2-polozhitel'nogo raka molochnoj zhelezy. Analiz predpochtenij vrachej v Rossijskoj Federacii]. Medicinskij alfavit. 2023;(27):7–12. (In Russ.). https://doi.org/10.33667/2078-5631-2023-27-7-12.

39. Levi M., Goshen-Lago T., Yerushalmi R. et al. Anti-HER2/neu antibody reduces chemotherapy-induced ovarian toxicity-from bench to bedside. Biomedicines. 2020;8(12):577. https://doi.org/10.3390/biomedicines8120577.

40. Lambertini M., Campbell C., Bines J. et al. Adjuvant anti-HER2 therapy, treatment-related amenorrhea, and survival in premenopausal HER2-positive early breast cancer patients. J Natl Cancer Inst. 2019;111(1):86–94. https://doi.org/10.1093/jnci/djy094.

41. Adamyan L.V., Nosov V.B., Stepanian A.A. Fertility-sparing treatment in cancer patients: how can we help in the 21st century? [Lechenie, sohranyayushchee fertil'nost' u onkologicheskih pacientov: chem my mozhem pomoch' v XXI veke?]. Problemy reprodukcii. 2024;30(1):26–63. (In Russ.). https://doi.org/10.17116/repro20243001126.

42. Poorvu P.D., Hu J., Zheng Y. et al. Treatment-related amenorrhea in a modern, prospective cohort study of young women with breast cancer. NPJ Breast Cancer. 2021;7(1):99. https://doi.org/10.1038/s41523-021-00307-8.

43. Dashyan G.A., Semiglazov V.F., Krivorot’ko P.V. et al. New prospects in the use of Kadcyla® in breast cancer. [Novye perspektivy primeneniya preparata Kadsila® pri rake molochnoj zhelezy]. Opuholi zhenskoj reproduktivnoj sistemy. 2015;11(4):46–52. (In Russ.). https://doi.org/10.17650/1994-4098-2015-11-4-46-52.

44. Cui W., Francis P.A., Loi S. et al. Assessment of ovarian function in phase III (neo)adjuvant breast cancer clinical trials: a systematic evaluation. J Natl Cancer Inst. 2021;113(12):1770–8. https://doi.org/10.1093/jnci/djab111.

45. Afonin G.V., Ragulin Y.A., Gulidov I.А. et al. Efficacy of hypofractionated adjuvant radiation therapy in patients with operable breast cancer. [Effektivnost' ad"yuvantnoj luchevoj terapii v rezhime gipofrakcionirovaniya u bol'nyh operabel'nym rakom molochnoj zhelezy]. Sibirskij onkologicheskij zhurnal. 2018;17(5):37–44. (In Russ.). https://doi.org/10.21294/1814-4861-2018-17-5-37-44.

46. Beyer S., Sandu A., White J. Impact and timing of breast cancerradiation therapy and fertility preservation. Curr Breast Cancer Rep. 2020;12(4):375–80. https://doi.org/10.1007/s12609-020-00394-9.

47. Krasnopol'skaia K.V., Krstich E.V., Gorskaia O.S. et al. The place of gonadotropin-releasing hormone agonists in reproductive medicine. [Mesto agonistov gonadotropin-rilizing-gormonov v reproduktivnoj medicine]. Problemy reprodukcii. 2012;(2):65–7. (In Russ.).

48. Pustotina O.A. Agonists of gonadotropin-releasing-hormone and add-back-therapy. [Agonisty gonadotropin-rilizing-gormona i add-back-terapiya]. Rossijskij vestnik akushera-ginekologa. 2023;23(2):63–9. (In Russ.). https://doi.org/10.17116/rosakush20232302163.

49. Li Z.Y., Dong Y.L., Cao X.Z. et al. Gonadotropin-releasing hormone agonists for ovarian protection during breast cancer chemotherapy: a systematic review and meta-analysis. Menopause. 2022;29(9):1093–100. https://doi.org/10.1097/GME.0000000000002019.

50. Lambertini M., Boni .L, Michelotti A. et al. Ovarian suppression with triptorelin during adjuvant breast cancer chemotherapy and long-term ovarian function, pregnancies, and disease-free survival: a randomized clinical trial. JAMA. 2015;314(24):2632–40. https://doi.org/10.1001/jama.2015.17291.

51. Krasnopol'skaia K.V., Nazarenko T.A., Zdanovskiĭ V.M. et al. The impact of quantitative parameters of folliculogenesis in controlled ovarian stimulation on IVF. [Vliyanie kolichestvennyh parametrov follikulogeneza pri kontroliruemoj stimulyacii yaichnikov na effektivnost' EKO]. Problemy reprodukcii. 2017;23(3):55–61. (In Russ.). https://doi.org/10.17116/repro201723355-61.

52. Park S.Y., Jeong K., Cho E.H., Chung H.W. Controlled ovarian hyperstimulation for fertility preservation in women with breast cancer: practical issues. Clin Exp Reprod Med. 2021;48(1):1–10. https://doi.org/10.5653/cerm.2020.03594.

53. Cavagna F., Pontes A., Cavagna M. et al. Specific protocols of controlled ovarian stimulation for oocyte cryopreservation in breast cancer patients. Curr Oncol. 2018;25(6):e527–e532. https://doi.org/10.3747/co.25.3889.

54. Baig A.S., Camuñas N.G., Sánchez P.P. et al. Controlled ovarian stimulation initiated at different phases of the menstrual cycle for fertility preservation in oncological patients: a retrospective study. Reprod Sci. 2023;30(8):2547–53. https://doi.org/10.1007/s43032-023-01175-2.

55. Cascante S.D., Berkeley A.S., Licciardi F. et al. Planned oocyte cryopreservation: the state of the ART. Reprod Biomed Online. 2023;47(6):103367. https://doi.org/10.1016/j.rbmo.2023.103367.

56. Lambertini M., Peccatori F.A., Demeestere I. et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2020;31(12):1664–78. https://doi.org/10.1016/j.annonc.2020.09.006.

57. Mahajan N. Fertility preservation in female cancer patients: an overview. J Hum Reprod Sci. 2015;8(1):3–13. https://doi.org/10.4103/0974-1208.153119.

58. Rosenberg E., Fredriksson A., Einbeigi Z. et al. No increased risk of relapse of breast cancer for women who give birth after assisted conception. Hum Reprod Open. 2019;2019(4):hoz039. https://doi.org/10.1093/hropen/hoz039.

59. Arecco L., Blondeaux E., Bruzzone M. et al. Safety of fertility preservation techniques before and after anticancer treatments in young women with breast cancer: a systematic review and meta-analysis. Hum Reprod. 2022;37(5):954–68. https://doi.org/10.1093/humrep/deac035.

60. Fraison E., Huberlant S., Labrune E. et al. Live birth rate after female fertility preservation for cancer or haematopoietic stem cell transplantation: a systematic review and meta-analysis of the three main techniques; embryo, oocyte and ovarian tissue cryopreservation. Hum Reprod. 2023;38(3):489–502. https://doi.org/10.1093/humrep/deac249.

61. Da Luz C.M., Caetano M.A., Berteli T.S. et al. The impact of oocyte vitrification on offspring: a systematic review. Reprod Sci. 2022;29(11):3222–34. https://doi.org/10.1007/s43032-022-00868-4.

62. Yupatov E.Yu., Kurmanbaev T.E., Shmidt A.A. et al. Cryopreservation of reproductive tissue – the possibility of preserving fertility (a review). [Kriokonservaciya reproduktivnoj tkani – vozmozhnost' sohraneniya fertil'nosti (obzor literatury)]. Problemy reprodukcii. 2020;26(5):99–106. (In Russ.). https://doi.org/10.17116/repro20202605199.

63. Rukhliada N.N., Kazantsev V.A. Oncofertility – an overview of modern methods of ovarian tissue cryopreservation. [Voprosy onkofertil'nosti – obzor sovremennyh metodov kriokonservacii yaichnikovoj tkani]. Problemy reprodukcii. 2018;24(1):53–6. (In Russ.). https://doi.org/10.17116/repro201824153-56.

64. Albamonte M.I., Vitullo A.D. Preservation of fertility in female and male prepubertal patients diagnosed with cancer. J Assist Reprod Genet. 2023;40(12):2755–67. https://doi.org/10.1007/s10815-023-02945-2.

65. Dolmans M.M., von Wolff M., Poirot C. et al. Transplantation of cryopreserved ovarian tissue in a series of 285 women: a review of five leading European centers. Fertil Steril. 2021;115(5):1102–15. https://doi.org/10.1016/j.fertnstert.2021.03.008.

66. Boutas I., Kontogeorgi A., Koufopoulos N. et al. Breast cancer and fertility preservation in young female patients: a systematic review of the literature. Clin Pract. 2023;13(6):1413–26. https://doi.org/10.3390/clinpract13060127.

67. Sánchez-Serrano M., Crespo J., Mirabet V. et al. Twins born after transplantation of ovarian cortical tissue and oocyte vitrification. Fertil Steril. 2010;93(1):268.e11–3. https://doi.org/10.1016/j.fertnstert.2009.09.046.

68. Jensen A.K., Macklon K.T., Fedder J. et al. 86 successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: focus on birth and perinatal outcome in 40 of these children. J Assist Reprod Genet. 2017;34(3):325–36. https://doi.org/10.1007/s10815-016-0843-9.

69. Klock S.C., Lindheim S.R. Disposition of unused cryopreserved embryos: opportunities and liabilities. Fertil Steril. 2023;119(1):1–2. https://doi.org/10.1016/j.fertnstert.2022.10.036.

70. Barcroft J., Dayoub N., Thong K.J. Fifteen year follow-up of embryos cryopreserved in cancer patients for fertility preservation. J Assist Reprod Genet. 2013;30(11):1407–13. https://doi.org/10.1007/s10815-013-0024-z.

71. Oktay K., Turan V., Bedoschi G. et al. Fertility preservation success subsequent to concurrent aromatase inhibitor treatment and ovarian stimulation in women with breast cancer. J Clin Oncol. 2015;33(22):2424–9. https://doi.org/10.1200/JCO.2014.59.3723.

72. Go K.J., Romanski P.A., Bortoletto P. et al. Meeting the challenge of unclaimed cryopreserved embryos. Fertil Steril. 2023;119(1):15–20. https://doi.org/10.1016/j.fertnstert.2022.09.323.

73. Pomeroy K.O., Comizzoli P., Rushing J.S. et al. The ART of cryopreservation and its changing landscape. Fertil Steril. 2022;117(3):469–76. https://doi.org/10.1016/j.fertnstert.2022.01.018.

74. Herraiz S., Buigues A., Díaz-García C. et al. Fertility rescue and ovarian follicle growth promotion by bone marrow stem cell infusion. Fertil Steril. 2018;109(5):908–918.e2. https://doi.org/10.1016/j.fertnstert.2018.01.004.

75. Umer A., Khan N., Greene D.L. et al. The therapeutic potential of human umbilical cord derived mesenchymal stem cells for the treatment of premature ovarian failure. Stem Cell Rev Rep. 2023;19(3):651–66. https://doi.org/10.1007/s12015-022-10493-y.

76. Del-Pozo-Lérida S., Salvador C., Martínez-Soler F. et al. Preservation of fertility in patients with cancer (Review). Oncol Rep. 2019;41(5):2607–14. https://doi.org/10.3892/or.2019.7063.

77. Peng X., Cheng C., Zhang X. et al. Design and application strategies of natural polymer Biomaterials in artificial ovaries. Ann Biomed Eng. 2023;51(3):461–78. https://doi.org/10.1007/s10439-022-03125-6.

78. Wu T., Gao Y.Y., Su J. et al. Three-dimensional bioprinting of artificial ovaries by an extrusion-based method using gelatin-methacryloyl bioink. Climacteric. 2022;25(2):170–8. https://doi.org/10.1080/13697137.2021.1921726.

79. Pei W., Fu L., Guo W. et al. Efficacy and safety of mesenchymal stem cell therapy for ovarian ageing in a mouse model. Stem Cell Res Ther. 2024;15(1):96. https://doi.org/10.1186/s13287-024-03698-0.

80. Jones G., Hughes J., Mahmoodi N. et al. What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum Reprod Update. 2017;23(4):433–57. https://doi.org/10.1093/humupd/dmx009.

81. Barjasteh S., Farnam F., Elsous A. et al. Overcoming reproductive and psychological concerns of breast cancer survivors: a randomized controlled Trial. J Family Reprod Health. 2022;16(1):52–60. https://doi.org/10.18502/jfrh.v16i1.8594.

82. Logan S., Anazodo A. The psychological importance of fertility preservation counseling and support for cancer patients. Acta Obstet Gynecol Scand. 2019;98(5):583–97. https://doi.org/10.1111/aogs.13562.

83. Ko J.K.Y., Cheung C.S.Y., Cheng H.H.Y. et al. Knowledge, attitudes and intention on fertility preservation among breast cancer patients. Sci Rep. 2023;13(1):9645. https://doi.org/10.1038/s41598-023-36377-w.

84. Petrov I.A., Dmitrieva M.L., Tikhonovskaya O.A. et al. The current view of natural fertility. [Sovremennyj vzglyad na estestvennuyu fertil'nost']. Rossijskij vestnik akushera-ginekologa. 2017;17(2):4–12. (In Russ.). https://doi.org/10.17116/rosakush20171724-12.