Плановое сохранение фертильности у женщин: криоконсервация ооцитов и ткани яичника – эффективность, безопасность и правовые аспекты

Плановое сохранение фертильности (ПСФ) становится все более востребованной стратегией для женщин, откладывающих материнство. Среди доступных технологий наибольшее распространение получила плановая криоконсервация ооцитов (ПКО), тогда как криоконсервация ткани яичников рассматривается как перспективная альтернатива с уникальными преимуществами – возможностью восстановления естественной фертильности и эндокринной функции. Совершенствование методов витрификации значительно повысило показатели выживаемости и оплодотворяемости ооцитов, однако остаются нерешенными вопросы оптимального числа клеток для замораживания, целесообразного возраста проведения процедуры и экономической эффективности в разных группах пациенток. Наиболее убедительные данные свидетельствуют о том, что проведение ПКО в более молодом возрасте связано с более высокими показателями живорождения и меньшей необходимостью в повторных циклах стимуляции. Доказано, что длительное хранение не снижает жизнеспособность ооцитов и не оказывает негативного влияния на здоровье детей. Современные исследования не выявляют повышения акушерских и перинатальных рисков у потомства, рожденного из замороженных ооцитов, однако требуется дальнейшее изучение долгосрочных и межпоколенческих последствий. Этические и правовые аспекты продолжают активно обсуждаться. Несмотря на широкое признание ПКО, нормативно-правовые подходы существенно различаются в разных странах. В Российской Федерации ПСФ разрешено и применяется на практике, хотя формальные возрастные ограничения не определены. Таким образом, ПСФ расширяет репродуктивную автономию женщин, но требует тщательного консультирования с учетом реальных шансов на успех, возраста, сопутствующих рисков и финансовых ограничений. Перспективы развития связаны со стандартизацией клинических протоколов, повышением информированности и формированием поддерживающей государственной политики.

1. Ростовская Т.К., Золотарева О.А. Демографическая стабильность как приоритет демографической политики Российской Федерации. Вопросы управления. 2022;(3):6–18. https://doi.org/10.22394/2304-3369-2022-3-6-18.

2. Nasab S., Ulin L., Nkele C. et al. Elective egg freezing: what is the vision of women around the globe? Future Sci OA. 2020;6(5):FSO468. https://doi.org/10.2144/fsoa-2019-0068.

3. Архангельский В.Н., Калачикова О.Н. Возраст матери при рождении первого ребенка: динамика, региональные различия, детерминация. Экономические и социальные перемены: факты, тенденции, прогноз. 2020;13(5):200–17. https://doi.org/10.15838/esc.2020.5.71.1.

4. Bongaarts J., Blanc A.K. Estimating the current mean age of mothers at the birth of their first child from household surveys. Popul Health Metr. 2015;13:25. https://doi.org/10.1186/s12963-015-0058-9.

5. Kasaven L.S., Mitra A., Ostrysz P. et al. Exploring the knowledge, attitudes, and perceptions of women of reproductive age towards fertility and elective oocyte cryopreservation for age-related fertility decline in the UK: a cross-sectional survey. Hum Reprod. 2023;38(12):2478–88. https://doi.org/10.1093/humrep/dead200.

6. Gonda K.J., Domar A.D., Gleicher N., Marrs R.P. Insights from clinical experience in treating IVF poor responders. Reprod Biomed Online. 2018;36(1):12–9. https://doi.org/10.1016/j.rbmo.2017.09.016.

7. Camaioni A., Ucci M.A., Campagnolo L. et al. The process of ovarian aging: it is not just about oocytes and granulosa cells. J Assist Reprod Genet. 2022;39(4):783–92. https://doi.org/10.1007/s10815-022-02478-0.

8. Юпатов Е.Ю., Курманбаев Т.Е., Шмидт А.А. и др. Криоконсервация репродуктивной ткани – возможность сохранения фертильности (обзор литературы). Проблемы репродукции. 2020;26(5):99–106. https://doi.org/10.17116/repro20202605199.

9. Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013;99(1):37–43. https://doi.org/10.1016/j.fertnstert.2012.09.028.

10. ESHRE Task Force on Ethics and Law, including, Dondorp W., de Wert G., Pennings G. et al. Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012;27(5):1231–7. https://doi.org/10.1093/humrep/des029.

11. Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org; Ethics Committee of the American Society for Reproductive Medicine. Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: an Ethics Committee opinion. Fertil Steril. 2018;110(6):1022–8. https://doi.org/10.1016/j.fertnstert.2018.08.027.

12. Johnston M., Richings N.M., Leung A.et al. A major increase in oocyte cryopreservation cycles in the USA, Australia and New Zealand since 2010 is highlighted by younger women but a need for standardized data collection. Hum Reprod. 2021;36(3):624–35. https://doi.org/10.1093/humrep/deaa320.

13. Cobo A., García-Velasco J.A., Remohí J., Pellicer A. Oocyte vitrification for fertility preservation for both medical and nonmedical reasons. Fertil Steril. 2021;115(5):1091–101. https://doi.org/10.1016/j.fertnstert.2021.02.006.

14. Lew R., Foo J., Kroon B. et al. ANZSREI consensus statement on elective oocyte cryopreservation. Aust N Z J Obstet Gynaecol. 2019;59(5):616–26. https://doi.org/10.1111/ajo.13028.

15. Kasaven L.S., Saso S., Getreu N. et al. Age-related fertility decline: is there a role for elective ovarian tissue cryopreservation? Hum Reprod. 2022;37(9):1970–9. https://doi.org/10.1093/humrep/deac144.

16. Magnus M.C., Wilcox A.J., Morken N.H. et al. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. BMJ. 2019;364:l869. https://doi.org/10.1136/bmj.l869.

17. te Velde E., Habbema D., Leridon H., Eijkemans M. The effect of postponement of first motherhood on permanent involuntary childlessness and total fertility rate in six European countries since the 1970s. Hum Reprod. 2012;27(4):1179–83. https://doi.org/10.1093/humrep/der455.

18. Leridon H., Slama R. The impact of a decline in fecundity and of pregnancy postponement on final number of children and demand for assisted reproduction technology. Hum Reprod. 2008;23(6):1312–9. https://doi.org/10.1093/humrep/den106.

19. Nybo Andersen A.M., Wohlfahrt J., Christens P. et al. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708–12. https://doi.org/10.1136/bmj.320.7251.1708.

20. Habbema J.D., Eijkemans M.J., Leridon H., te Velde E.R. Realizing a desired family size: when should couples start? Hum Reprod. 2015;30(9):2215–21. https://doi.org/10.1093/humrep/dev148.

21. Салий М.Г., Ткаченко Л.В., Селина Е.Г. и др. Репродуктивный потенциал современных молодых женщин. Астраханский медицинский журнал. 2022;17(3):66–71. https://doi.org/10.48612/agmu/2022.17.3.66.71.

22. Hansen K.R., Knowlton N.S., Thyer A.C. et al. A new model of reproductive aging: the decline in ovarian non-growing follicle number from birth to menopause. Hum Reprod. 2008;23(3):699–708. https://doi.org/10.1093/humrep/dem408.

23. Hassold T., Hunt P. To err (meiotically) is human: the genesis of human aneuploidy. Nat Rev Genet. 2001;2(4):280–91. https://doi.org/10.1038/35066065.

24. de Toda I.M., Ceprián N., Díaz-Del Cerro E., De la Fuente M. The role of immune cells in oxi-inflamm-aging. Cells. 2021;10(11):2974. https://doi.org/10.3390/cells10112974.

25. Hodes-Wertz B., Druckenmiller S., Smith M., Noyes N. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility? Fertil Steril. 2013;100(5):1343–9. https://doi.org/10.1016/j.fertnstert.2013.07.201.

26. Pedro J., Brandão T., Schmidt L. et al. What do people know about fertility? A systematic review on fertility awareness and its associated factors. Ups J Med Sci. 2018;123(2):71–81. https://doi.org/10.1080/03009734.2018.1480186.

27. Nasab S., Shah J.S., Nurudeen K. et al. Physicians' attitudes towards using elective oocyte cryopreservation to accommodate the demands of their career. J Assist Reprod Genet. 2019;36(9):1935–47. https://doi.org/10.1007/s10815-019-01541-7.

28. Fritz R., Klugman S., Lieman H. et al. Counseling patients on reproductive aging and elective fertility preservation-a survey of obstetricians and gynecologists' experience, approach, and knowledge. J Assist Reprod Genet. 2018;35(9):1613–21. https://doi.org/10.1007/s10815-018-1273-7.

29. Cobo A., García-Velasco J.A., Coello A. et al. Oocyte vitrification as an efficient option for elective fertility preservation. Fertil Steril. 2016;105(3):755–764.e8. https://doi.org/10.1016/j.fertnstert.2015.11.027.

30. Giannopapa M., Sakellaridi A., Pana A., Velonaki V.S. Women electing oocyte cryopreservation: characteristics, information sources, and oocyte disposition: a systematic review. J Midwifery Womens Health. 2022;67(2):178–201. https://doi.org/10.1111/jmwh.13332.

31. Blakemore J.K., Bayer A.H., Smith M.B., Grifo J.A. Infertility influencers: an analysis of information and influence in the fertility webspace. J Assist Reprod Genet. 2020;37(6):1371–8. https://doi.org/10.1007/s10815-020-01799-2.

32. Baldwin K., Culley L., Hudson N. et al. Oocyte cryopreservation for social reasons: demographic profile and disposal intentions of UK users. Reprod Biomed Online. 2015;31(2):239–45. https://doi.org/10.1016/j.rbmo.2015.04.010.

33. Inhorn M.C., Birenbaum-Carmeli D., Westphal L.M. et al. Ten pathways to elective egg freezing: a binational analysis. J Assist Reprod Genet. 2018;35(11):2003–11. https://doi.org/10.1007/s10815-018-1277-3.

34. Jones B.P., Kasaven L., L'Heveder A. et al. Perceptions, outcomes, and regret following social egg freezing in the UK; a cross-sectional survey. Acta Obstet Gynecol Scand. 2020;99(3):324–32. https://doi.org/10.1111/aogs.13763.

35. Dahhan T., Dancet E.A., Miedema D.V. et al. Reproductive choices and outcomes after freezing oocytes for medical reasons: a follow-up study. Hum Reprod. 2014;29(9):1925–30. https://doi.org/10.1093/humrep/deu137.

36. Stoop D., Maes E., Polyzos N.P. et al. Does oocyte banking for anticipated gamete exhaustion influence future relational and reproductive choices? A follow-up of bankers and non-bankers. Hum Reprod. 2015;30(2):338–44. https://doi.org/10.1093/humrep/deu317.

37. Rienzi L., Ubaldi F.M. Oocyte versus embryo cryopreservation for fertility preservation in cancer patients: guaranteeing a women's autonomy. J Assist Reprod Genet. 2015;32(8):1195–6. https://doi.org/10.1007/s10815-015-0507-1.

38. Kristensen S.G., Andersen C.Y. Cryopreservation of ovarian tissue: opportunities beyond fertility preservation and a positive view into the future. Front Endocrinol (Lausanne). 2018;9:347. https://doi.org/10.3389/fendo.2018.00347.

39. Oktay K.H., Marin L., Petrikovsky B. et al. Delaying reproductive aging by ovarian tissue cryopreservation and transplantation: is it prime time? Trends Mol Med. 2021;27(8):753–61. https://doi.org/10.1016/j.molmed.2021.01.005.

40. Chen C. Pregnancy after human oocyte cryopreservation. Lancet. 1986;1(8486):884–6. https://doi.org/10.1016/s0140-6736(86)90989-x.

41. Argyle C.E., Harper J.C., Davies M.C. Oocyte cryopreservation: where are we now? Hum Reprod Update. 2016;22(4):440–9. https://doi.org/10.1093/humupd/dmw007.

42. Kuwayama M. Highly efficient vitrification for cryopreservation of human oocytes and embryos: the Cryotop method. Theriogenology. 2007;67(1):73–80. https://doi.org/10.1016/j.theriogenology.2006.09.014.

43. Gil-Arribas E., Blockeel C., Pennings G. et al. Oocyte vitrification for elective fertility preservation: a SWOT analysis. Reprod Biomed Online. 2022;44(6):1005–14. https://doi.org/10.1016/j.rbmo.2022.02.001.

44. Cascante S.D., Blakemore J.K., DeVore S. et al. Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility center. Fertil Steril. 2022;118(1):158–66. https://doi.org/10.1016/j.fertnstert.2022.04.013.

45. Cobo A., García-Velasco J., Domingo J. et al. Elective and onco-fertility preservation: factors related to IVF outcomes. Hum Reprod. 2018;33(12):2222–31. https://doi.org/10.1093/humrep/dey321.

46. Walker Z., Lanes A., Ginsburg E. Oocyte cryopreservation review: outcomes of medical oocyte cryopreservation and planned oocyte cryopreservation. Reprod Biol Endocrinol. 2022;20(1):10. https://doi.org/10.1186/s12958-021-00884-0.

47. Doyle J.O., Richter K.S., Lim J. et al. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertil Steril. 2016;105(2):459–466.e2. https://doi.org/10.1016/j.fertnstert.2015.10.026.

48. Hirsch A., Hirsh Raccah B., Rotem R. et al. Planned oocyte cryopreservation: a systematic review and meta-regression analysis. Hum Reprod Update. 2024;30(5):558–68. https://doi.org/10.1093/humupd/dmae009.

49. Orvieto R. What is the expected live birth rate per thawed oocyte? Hum Reprod Update. 2024;30(5):648–9. https://doi.org/10.1093/humupd/dmae015.

50. Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline. Fertil Steril. 2021;116(1):36–47. https://doi.org/10.1016/j.fertnstert.2021.02.024.

51. Miner S.A., Miller W.K., Grady C., Berkman B.E. "It's just another added benefit": women's experiences with employment-based egg freezing programs. AJOB Empir Bioeth. 2021;12(1):41–52. https://doi.org/10.1080/23294515.2020.1823908.

52. Lockwood G., Fauser B.C. Social egg freezing: who chooses and who uses? Reprod Biomed Online. 2018;37(4):383–4. https://doi.org/10.1016/j.rbmo.2018.08.003.

53. Franasiak J.M., Forman E.J., Hong K.H. et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101(3):656–663.e1. https://doi.org/10.1016/j.fertnstert.2013.11.004.

54. Iglesias C., Banker M., Mahajan N. et al. Ethnicity as a determinant of ovarian reserve: differences in ovarian aging between Spanish and Indian women. Fertil Steril. 2014;102(1):244–9. https://doi.org/10.1016/j.fertnstert.2014.03.050.

55. Porcu E., Cillo G.M., Cipriani L. et al. Impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes in young women with breast cancer. J Assist Reprod Genet. 2020;37(3):709–15. https://doi.org/10.1007/s10815-019-01658-9.

56. Wennberg A.L. Social freezing of oocytes: a means to take control of your fertility. Ups J Med Sci. 2020;125(2):95–8. https://doi.org/10.1080/03009734.2019.1707332.

57. Tsafrir A., Ben-Ami I., Eldar-Geva T. et al. Clinical outcome of planned oocyte cryopreservation at advanced age. J Assist Reprod Genet. 2022;39(11):2625–33. https://doi.org/10.1007/s10815-022-02633-7.

58. Ovarian Stimulation TEGGO, Bosch E., Broer S., Griesinger G. et al. ESHRE guideline: ovarian stimulation for IVF/ICSI†. Hum Reprod Open. 2020;2020(2):hoaa009. https://doi.org/10.1093/hropen/hoaa009.

59. Giles J., Cruz M., Cobo A. et al. Medroxyprogesterone acetate: an alternative to GnRH-antagonist in oocyte vitrification for social fertility preservation and preimplantation genetic testing for aneuploidy. Reprod Biomed Online. 2023;47(2):103222. https://doi.org/10.1016/j.rbmo.2023.04.013.

60. Pai A.H., Sung Y.J., Li C.J. et al. Progestin Primed Ovarian Stimulation (PPOS) protocol yields lower euploidy rate in older patients undergoing IVF. Reprod Biol Endocrinol. 2023;21(1):72. https://doi.org/10.1186/s12958-023-01124-3.

61. Lee S.S., Sutter M., Lee S. et al. Self-reported quality of life scales in women undergoing oocyte freezing versus in vitro fertilization. J Assist Reprod Genet. 2020;37(10):2419–25. https://doi.org/10.1007/s10815-020-01916-1.

62. Sandhu S., Hickey M., Koye D.N. et al. Eggsurance? A randomized controlled trial of a decision aid for elective egg freezing. Hum Reprod. 2024;39(8):1724–34. https://doi.org/10.1093/humrep/deae121.

63. Greenwood E.A., Pasch L.A., Hastie J. et al. To freeze or not to freeze: decision regret and satisfaction following elective oocyte cryopreservation. Fertil Steril. 2018;109(6):1097–1104.e1. https://doi.org/10.1016/j.fertnstert.2018.02.127.

64. Platts S., Trigg B., Bracewell-Milnes T. et al. Exploring women's attitudes, knowledge, and intentions to use oocyte freezing for non-medical reasons: a systematic review. Acta Obstet Gynecol Scand. 2021;100(3):383–93. https://doi.org/10.1111/aogs.14030.

65. Tsafrir A., Holzer H., Miron-Shatz T. et al. 'Why have women not returned to use their frozen oocytes?': a 5-year follow-up of women after planned oocyte cryopreservation. Reprod Biomed Online. 2021;43(6):1137–45. https://doi.org/10.1016/j.rbmo.2021.08.026.

66. Loreti S., Darici E., Nekkebroeck J. et al. A 10-year follow-up of reproductive outcomes in women attempting motherhood after elective oocyte cryopreservation. Hum Reprod. 2024;39(2):355–63. https://doi.org/10.1093/humrep/dead267.

67. Kakkar P., Geary J., Stockburger T. et al. Outcomes of social egg freezing: a cohort study and a comprehensive literature review. J Clin Med. 2023;12(13):4182. https://doi.org/10.3390/jcm12134182.

68. Leung A.Q., Baker K., Vaughan D. et al. Clinical outcomes and utilization from over a decade of planned oocyte cryopreservation. Reprod Biomed Online. 2021;43(4):671–9. https://doi.org/10.1016/j.rbmo.2021.06.024.

69. Cascante S.D., Grifo J.A., Licciardi F. et al. The effects of age, mature oocyte number, and cycle number on cumulative live birth rates after planned oocyte cryopreservation. J Assist Reprod Genet. 2024;41(11):2979–85. https://doi.org/10.1007/s10815-024-03175-w.

70. Caughey L.E., White K.M., Lensen S., Peate M. Elective egg freezers' disposition decisions: a qualitative study. Fertil Steril. 2023;120(1):145–60. https://doi.org/10.1016/j.fertnstert.2023.02.022.

71. 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.

72. Goldman K.N., Kramer Y., Hodes-Wertz B. et al. Long-term cryopreservation of human oocytes does not increase embryonic aneuploidy. Fertil Steril. 2015;103(3):662–8. https://doi.org/10.1016/j.fertnstert.2014.11.025.

73. Stigliani S., Moretti S., Anserini P. et al. Storage time does not modify the gene expression profile of cryopreserved human metaphase II oocytes. Hum Reprod. 2015;30(11):2519–26. https://doi.org/10.1093/humrep/dev232.

74. Van Reckem M., Blockeel C., Bonduelle M. et al. Health of 2-year-old children born after vitrified oocyte donation in comparison with peers born after fresh oocyte donation. Hum Reprod Open. 2021;2021(1):hoab002. https://doi.org/10.1093/hropen/hoab002.

75. 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.

76. Katsani D., Paraschou N., Panagouli E. et al. Social egg freezing – a trend or modern reality? J Clin Med. 2024;13(2):390. https://doi.org/10.3390/jcm13020390.

77. Fuchs Weizman N., Baram S., Montbriand J., Librach C.L. Planned oocyte cryopreservation (Planned OC): systematic review and meta-analysis of cost-efficiency and patients' perspective. BJOG. 2021;128(6):950–62. https://doi.org/10.1111/1471-0528.16555.

78. van Loendersloot L.L., Moolenaar L.M., Mol B.W. et al. Expanding reproductive lifespan: a cost-effectiveness study on oocyte freezing. Hum Reprod. 2011;26(11):3054–60. https://doi.org/10.1093/humrep/der284.

79. Yang I.J., Wu M.Y., Chao K.H. et al. Usage and cost-effectiveness of elective oocyte freezing: a retrospective observational study. Reprod Biol Endocrinol. 2022;20(1):123. https://doi.org/10.1186/s12958-022-00996-1.

80. Devine K., Mumford S.L., Goldman K.N. et al. Baby budgeting: oocyte cryopreservation in women delaying reproduction can reduce cost per live birth. Fertil Steril. 2015;103(6):1446–1453.e1-2. https://doi.org/10.1016/j.fertnstert.2015.02.029.

81. Stoop D., Nekkebroeck J., Devroey P. A survey on the intentions and attitudes towards oocyte cryopreservation for non-medical reasons among women of reproductive age. Hum Reprod. 2011;26(3):655–61. https://doi.org/10.1093/humrep/deq367.

82. Blakemore J.K., Grifo J.A., DeVore S.M. et al. Planned oocyte cryopreservation-10-15-year follow-up: return rates and cycle outcomes. Fertil Steril. 2021;115(6):1511–20. https://doi.org/10.1016/j.fertnstert.2021.01.011.

83. Paulson R.J., Boostanfar R., Saadat P. et al. Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age. JAMA. 2002;288(18):2320–3. https://doi.org/10.1001/jama.288.18.2320.

84. ESHRE Guideline Group on Female Fertility Preservation; Anderson R.A., Amant F., Braat D. et al. ESHRE guideline: female fertility preservation. Hum Reprod Open. 2020;2020(4):hoaa052. https://doi.org/10.1093/hropen/hoaa052.

85. Selter J.H., Woodward J., Neal S. Survey assessing policies regarding patient age and provision of fertility treatment in the United States. J Assist Reprod Genet. 2023;40(9):2117–27. https://doi.org/10.1007/s10815-023-02877-x.

86. Stoop D., van der Veen F., Deneyer M. et al. Oocyte banking for anticipated gamete exhaustion (AGE) is a preventive intervention, neither social nor nonmedical. Reprod Biomed Online. 2014;28(5):548–51. https://doi.org/10.1016/j.rbmo.2014.01.007.

87. Shkedi-Rafid S., Hashiloni-Dolev Y. Egg freezing for age-related fertility decline: preventive medicine or a further medicalization of reproduction? Analyzing the new Israeli policy. Fertil Steril. 2011;96(2):291–4. https://doi.org/10.1016/j.fertnstert.2011.06.024.

88. Zhong H., Liao Q., Liu J. et al. Expert consensus on multidisciplinary approach to the diagnosis and treatment of primary hyperparathyroidism in pregnancy in China. Endocrine. 2023;82(2):282–95. https://doi.org/10.1007/s12020-023-03392-w.

89. Stern C.J., Gook D., Hale L.G. et al. Delivery of twins following heterotopic grafting of frozen-thawed ovarian tissue. Hum Reprod. 2014;29(8):1828. https://doi.org/10.1093/humrep/deu119.

90. Tammiste T., Kask K., Padrik P. et al. A case report and follow-up of the first live birth after heterotopic transplantation of cryopreserved ovarian tissue in Eastern Europe. BMC Womens Health. 2019;19(1):65. https://doi.org/10.1186/s12905-019-0764-8.

91. Pacheco F., Oktay K. Current success and efficiency of autologous ovarian transplantation: a meta-analysis. Reprod Sci. 2017;24(8):1111–20. https://doi.org/10.1177/1933719117702251.

92. Rosendahl M., Simonsen M.K., Kjer J.J. The influence of unilateral oophorectomy on the age of menopause. Climacteric. 2017;20(6):540–4. https://doi.org/10.1080/13697137.2017.1369512.