Xiangyan Ruan

We evaluated whether ovarian tissue cryopreservation (OTC) is a viable option for girls and young women who have already undergone hematopoietic stem cell transplantation (HSCT). We enrolled 142 patients who underwent OTC either before or after HSCT. Participants were categorized into three groups: "after HSCT group" (n = 16), "no-chemo group" before OTC (n = 75), and "chemo group" before OTC (n = 51). The after HSCT cohort had a mean age of 12.06 years at OTC, with half being pre-pubertal. Comparative analysis across age (0-12 and 13-24 years) revealed that the after-HSCT group consistently presented with significantly elevated FSH and diminished AMH levels relative to the no-chemo group. Ovarian volume per ovary was also markedly reduced in the after-HSCT group compared to the no-chemo group across all ages. Crucially, the estimated total follicle count per ovary was significantly lower in the after-HSCT group than in both pre-HSCT groups among 0-12 years, and versus the "no-chemo group" in 13-24 years. This confirms pre-HSCT fertility preservation as the paramount strategy. However, OTC post-HSCT emerges as a viable salvage option for carefully selected patients, underscoring the need for long-term follow-up to identify candidates and expand fertility possibilities in survivorship care.

Approximately 9.2 million women and girls are diagnosed with cancer globally each year [1]. While advances in oncology have improved the 5-year survival rate to 68% [2], gonadotoxic treatments freq...

To study the effect of the traditional Chinese medicine Gushukang on bone mineral density (BMD) in perimenopausal and postmenopausal women. In this randomized trial, 156 women were assigned to three groups (n = 52 each): hormone therapy (HT), Chinese medicine (CM, Gushukang capsules), or combination therapy. Interventions lasted 6 months. Height, weight, and BMD were measured, and blood samples were taken to assess FSH, LH, E2, P, AST, ALT, BUN, and CRE levels before and after treatment. Changes in these indicators were compared. Of the 156 participants, 142 completed the study (HT: 49, CM: 42, combination: 51). The median ages (Q1, Q3) of the three groups were 51.00 (47.00, 53.50), 53.00 (49.00, 57.00), and 51.00 (45.25, 54.00) years, respectively, with no significant difference. Pretreatment BMD values (mg/cm³) were 115.10 (102.90, 118.80), 107.40 (88.50, 114.65), and 113.25 (100.20, 118.98) for the HT, CM, and combination groups, respectively. After 6 months of treatment, the combination group showed a significant increase in BMD after treatment compared with before treatment (p < 0.01). In the hormone therapy and combination groups, FSH and LH levels decreased significantly, while E2 levels increased significantly after treatment (p < 0.05), whereas no significant differences in these indicators were observed in the Chinese medicine group. No significant differences in liver or kidney function were found in any of the three groups before and after treatment. Both Gushukang and menopausal hormone therapy for 6 months can increase BMD in perimenopausal and postmenopausal women; however, combination therapy yields superior results.

To investigate the impact of comprehensive preconception management using combined oral contraceptives (COCs) and orlistat on live birth rates and pregnancy outcomes in overweight or obese women with polycystic ovary syndrome (PCOS), aimed at optimizing preconception management strategies. This prospective cohort study enrolled 235 overweight or obese PCOS women aged 20-40 years. Participants were categorized into three preconception management groups: a DRSP/EE monotherapy group (n = 37), a DRSP/EE + orlistat combination therapy group (n = 71), and a non-medication control group (n = 127). All groups received individualized comprehensive management. The primary outcomes were live birth rate and incidence of pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). Secondary outcomes encompassed adverse pregnancy outcomes (APO), cesarean section rate, and neonatal complications. The incidence of GDM was significantly lower in the combination therapy group (31.9%) compared to the control group (56.6%) (P < 0.01). The DRSP/EE monotherapy group (33.3%) showed a decreasing trend, but statistical significance was not maintained after adjustment for multiple comparisons. While no statistically significant differences were observed in HDP, live birth rates, or APO among the groups (P > 0.05), the combination group exhibited the most favorable trends, achieving the highest live birth rate (97.2%) and the lowest APO rate (21.1%) compared to the monotherapy and control groups. Similarly, neonatal outcomes (preterm delivery, low birth weight, macrosomia) were comparable across groups, though the combination group showed numerically lower rates of preterm delivery and macrosomia. Multivariable logistic regression identified body mass index (BMI), fasting plasma glucose (FPG), fasting insulin (FINS), and total testosterone (TT) as independent risk factors for GDM, whereas both medication regimens were identified as significant protective factors. This study demonstrates that preconception combination therapy with DRSP/EE and orlistat significantly reduces the risk of GDM in overweight or obese women with PCOS. DRSP/EE monotherapy also exhibits a potential protective trend, although the effect is less robust compared to the combination regimen. While differences in HDP and other pregnancy outcomes did not reach statistical significance, the combination therapy group yielded the most favorable clinical profile, achieving the numerically highest live birth rate and the lowest incidence of adverse pregnancy outcomes. Comprehensive management targeting BMI and metabolic indicators is crucial for improving pregnancy prognosis in this population.

Turner syndrome (TS) girls experience accelerated ovarian reserve depletion, exhibiting a strong demand for ovarian tissue cryopreservation (OTC) to preser

To evaluate whether hypoxia-preconditioned human umbilical cord mesenchymal stem cells (hUCMSCs) can protect frozen-thawed human ovarian tissue via in vitro co-culture. Frozen-thawed ovarian cortical pieces from 10 patients were randomly divided into a control group (no co-culture), N‑MSCs group (normoxia‑preconditioned hUCMSCs co-culture), and H‑MSCs group (hypoxia‑preconditioned hUCMSCs co-culture). Tissues in the co-culture groups were subjected to 48 h indirect Transwell co-culture. Apoptosis was assessed by TUNEL. Metabolic changes in the culture medium were measured, such as glucose consumption and lactate production, and AMH levels were determined. Oxidative stress in ovarian tissue was evaluated by measuring ROS and TAC. RNA-seq was performed, and key pathways were analyzed by GSEA. The protein expression of HIF-1α, VEGFA, GDF9, AKT, and p-AKT was examined by Western blot. Compared with both the control and N-MSCs groups, co-culture with H‑MSCs significantly reduced follicular atresia and apoptosis, while preserving a greater proportion of resting follicles. The H‑MSCs group presented lower glucose consumption and lactate production and elevated AMH levels in the culture medium. H‑MSCs markedly decreased reactive oxygen species (ROS) and enhanced total antioxidant capacity (TAC). Transcriptomic analysis showed that H‑MSCs induced a distinct gene expression profile characterized by upregulation of the HIF‑1 signaling pathway. H‑MSCs significantly upregulated HIF‑1α, VEGFA, and phosphorylated AKT at the protein level. This in vitro study showed that co-culture of ovarian tissue with H-MSCs provides stronger protection than N-MSCs. This effect likely involves the HIF-1α/VEGFA pathway, with enhanced pro-angiogenic signaling, reduced apoptosis and oxidative stress, and preservation of the follicular reserve.

Ovarian tissue cryopreservation and transplantation is currently the only feasible method for preserving both fertility and ovarian endocrine function in prepubertal female patients. It is indicated for those requiring gonadotoxic therapies such as chemo-therapy, radiotherapy, or bone marrow transplantation for malignant diseases, as well as for non-malignant diseases, including immunologic, metabolic, and hematologic benign diseases requiring bone marrow transplantation, and other populations at high risk of premature ovarian insufficiency. The procedure involves laparoscopic retrieval of ovarian tissue, typically via unilateral oophorectomy in young patients, followed by slow-programmed cryopreservation. When the primary disease is cured and fertility or hormonal function restoration is desired, the tissue is thawed and transplanted, most commonly to an orthotopic site. For patients at high risk of ovarian malignancy involvement, pre-transplantation assessment of minimal residual disease in the ovarian cortex is performed using histo-pathology and molecular biology techniques. Globally, while ovarian tissue cryopreservation and transplantation has led to over 300 live births, the majority result from tissue cryopreserved after puberty. Successful restoration of puberty and subsequent live births following transplantation of tissue frozen before puberty, although demonstrated in reported cases, remain less common. Therefore, this review systematically summarizes recent advances in the indications, current application status, timing and strategies of ovarian tissue cryopreservation and transplantation, risk assessment of tumor cell reintroduction, and clinical outcomes in prepubertal patients. It also discusses the potential value and current challenges of combining this approach with in vitro oocyte maturation techniques, ainming to provide practical references for clinical practice.