Position of surgery in the management of female fertility preservation

Female fertility preservation (FP) is now a major quality-of-life issue, particularly for patients exposed to diseases or treatments with gonadotoxic effects. FP requires a multidisciplinary approach that extends beyond gynecology and should be systematically and proactively integrated into care pathways as soon as a risk to reproductive potential is identified. It is also relevant when medical management may delay a pregnancy plan, exposing women to conception at a later maternal age when natural fertility is significantly reduced.The physiological decline in ovarian reserve with age strongly influences the choice and effectiveness of available strategies.
Among surgical options, ovarian tissue cryopreservation is considered a first-line approach in cases of high gonadotoxic risk, especially in prepubertal patients. Following orthotopic autotransplantation, it allows restoration of endocrine function in most cases and provides opportunities for spontaneous pregnancy, with live birth rates estimated at approximately 30–40% per transplantation.
Ovarian transposition, indicated prior to pelvic radiotherapy, helps preserve endocrine function and may allow subsequent pregnancies, although data on fertility outcomes remain limited. In addition, innovative techniques such as uterine transposition aim to protect the uterus from the deleterious effects of pelvic irradiation, which can severely impair fertility and obstetric outcomes.
Integrating these strategies into coordinated care pathways, particularly through oncofertility networks, represents a major organizational challenge. The goal is to ensure equitable access to information and fertility preservation techniques, thereby optimizing the chances of future motherhood for affected women.