{"paper_id":"558669fd-da8d-462a-8160-37418f274aad","body_text":"Systematic Review Article | JOGCR. 2025; 10(5): 351-360 \n     Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \n Journal of Obstetrics, Gynecology and Cancer Research | ISSN: 2476-5848 \n \nOvarian Tissue Cryopreservation in Patients with Endometriosis: A \nSystematic Review of the Literature \n \nAchmad Kemal Harzif1* , Mila Maidarti1, Costan Tryono Parulian Rumapea2,  \nSarah Miriam Ratna Pratamasari2, Heidi Dewi Mutia3 , Nafi’atul Ummah3 ,  \nAisyah Retno Puspawardani3 , Putri Nurbaeti3 , Budi Wiweko1 \n \n1. Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, \nUniversitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia \n2. Department of Obstetrics and Gynecology, Faculty of Medicine, University Indonesia, Dr. Cipto Mangunkusumo \nHospital Jakarta, Jakarta, Indonesia \n3. Human Reproduction, Infertility, and Family Planning Cluster, Indonesia Reproductive Medicine Research and Training \nCenter, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia \n \nArticle Info  ABSTRACT \n  \n 10.30699/jogcr.10.5.351 \n \n \n \nBackground & Objective: Endometriosis is one of the primary etiology of subfertility \nin women; in severe cases, endometriosis surgery could result in infertility due to \noophorectomy. Ovarian tissue cryopreservation is a method by which the ovarian cortex \nis frozen and retransplanted in patients. This method is unaffected by the menstrual \ncycle, can restore ovarian hormonal function, and does not require sperm donor or \novulation induction. This systematic review aims to review the utility of ovarian tissue \ncryopreservation in endometriosis patients. \nMaterials & Methods: We searched the literature using keywords such as “fertility \npreservation,” “cryopreservation,” “endometriosis,” and “ovarian tissue \ncryopreservation” for relevant articles in Pubmed and Embase. We included all relevant \narticles, including case reports, cohort studies, and clinical trials. \nResults: A total of 6 articles were included in this systematic review, including three \nretrospective studies and three case reports. In screening for candidates of ovarian tissue \ncryopreservation, serum antimullerian hormone (AMH) is a good marker for primordial \nfollicle count. Patients undergoing ovarian tissue implantation after cryopreservation \ndemonstrated an excellent pregnancy rate (41.2%) in one study. Follicle viability and \nhormonal function were preserved post-transplantation.  \nConclusion: The current evidence shows that endocrine f unction and fertility in \npatients grafted with cryopreserved ovarian tissue are good. However, the evidence \non the long -term outcome of ovarian tissue cryopreservation in endometriosis \npatients is lacking. \nKeywords: Assisted Reproductive Technique, Endometriosis, Fertility \nPreservation, Ovarian Tissue Cryopreservation  \nReceived: 2024/01/02; \nAccepted: 2024/04/06; \nPublished Online: 13 Mar 2025; \n \n \nUse your device to scan and read the \narticle online \n \n \nCorresponding Information:  \nAchmad Kemal Harzif, \nReproductive Immunoendocrinology \nDivision, Department of Obstetrics and \nGynecology, Faculty of Medicine, \nUniversitas Indonesia, Dr. Cipto \nMangunkusumo General Hospital, Jakarta, \nIndonesia \n \nEmail: kemal.achmad@gmail.com  \n \n \nCopyright © 2025, This is an original open -access article distributed under the terms of the Creative Commons Attribution-noncommercial \n4.0 International License which permits copy and  redistribution of the material just in noncommercial usages with proper citation.  \n \n \n1. Introduction\nEndometriosis is defined as the existence of  \nendometrial tissue, including endometrial glands and \nstroma outside of the uterus , usually affecting the \nperitoneum and ovaries; it results in dysmenorrhea and \npremenstrual discomfort (1 -3). Endometriosis affects \napproximately 10- 15% of all women of reproductive \nage and contributes as one of the most common causes \nof infertility. About 25–50% of women with infertility \nhave endometriosis, and 30– 50% of women with \nendometriosis experience infertility (4). \nSeveral pathophysiologies underlying \nendometriosis-related infertility. In mild to moderate \nforms of endometriosis, ectopic endometrial tissue \ncould promote inflammation of the peritoneal cavity, \nwhich recruits macrophages and induces secretion of \nprostaglandin, IL -1, TNF, and proteases (4). \nInflammation can cause anatomical disorder and affect \novarian function. This condition leads to functional \nimpairment of oocytes, sperm, and embryo \nimplantation. Severe endometriosis can result in pelvic \norgan adhesion that impairs tubal patency, ovum \npickup, and/or ovum transport (4, 5). \n\n\nAchmad Kemal Harzif et al. 352 \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \nSevere endometriosis could also decrease ovarian \nreserve, irrespective of previous surgical history. In \naddition, the technique to treat severe endometriosis, \nsuch as excision and ablation could result in collateral \novarian tissue damage,  resulting in impaired ovarian \nfunction (6, 7) . The recurrence of endometriosis is \nrelatively high, nearing 50% after five years; it also \nfurther impairs ovarian function and fertility due to \nrecurrent surgery and destruction of nearby ovarian \ntissue (6). \nIn patients with severe endometriosis and worsening \novarian function despite adequate treatment, a fertility \npreservation technique could be considered to preserve \nthe patient's fertility after extensive impairment of \novarian function (8). Fertility preser vation technique \nhas been widely used in patients who will receive a \ngenotoxic treatment, such as chemotherapy (8, 9).  \nRecently, fertility preservation has also been offered to \npatients with premature ovarian insufficiency and \npatients who are at risk of p remature menopause, \nincluding iatrogenic ovarian insufficiency such as in \nsevere endometriosis patients undergoing ovarian \nsurgery (10-12). \nOvarian tissue vitrification or cryopreservation is a \nrelatively new ovarian preservation method in which \novarian cortex tissue is excised and preserved to be \nimplanted later. This method offers several advantages \nover traditional oocyte/embryo cryopreservation. One \nof its benefits is that it does not require ovarian \nhyperstimulation and a sperm donor. Additionally, it \nprovides the possibility of restoring ovarian hormonal \nfunction. Moreover, ovarian tissue cryopreservation \n(OTC) is often preferred in many cases besides \nendometriosis due to its low risk of metastases to \novaries (13-16). \nOvarian tissue cryopreservation has been used in \nendometriosis with convincing results. However, the \nevidence of ovarian tissue cryopreservation in \nendometriosis is scarce. This systematic review aims to \nsummarize the current evidence on ovarian tissue \ncryopreservation in endometriosis patients.  \n \n2. Materials and Methods \nWe searched Pubmed and Embase for relevant \nliterature using keywords such as “Ovarian tissue \nvitrification,” “ovarian tissue cryopreservation,” \n“endometriosis,” “endometrioma,” and “fertility \npreservation.” The total keywords for literature \nsearching are listed in Table 1\n. After retrieving studies, \nwe conducted deduplication for duplicate studies, \nscreening the abstracts of the studies retrieved. We then \nretrieved the entire manuscript for the screened \nabstract. Critical appraisals were then conducted for \nrespective studies using the JBI checklist for case \nreports, cross -sectional studies, and cohort studies. \nData were then summarized using tables. \n \nTable 1. Keywords for Literature Searching \nDatabase Keywords Hits \nPubmed \n((\"endometrioma\"[All Fields]) OR \n(\"endometriosis\"[All Fields])) \nAND \n((\"fertility preservation\"[All Fields]) \nOR (\"ovarian cryopreservation\"[All \nFields]) OR (\"cryopreservation\"[All \nFields]) OR (\"ovarian tissue \ncryopreservation\"[All Fields])) \n244 \nEmbase \n('endometrioma'/exp OR endometrioma \nOR 'endometriosis'/exp OR \nendometriosis) AND ('fertility \npreservation'/exp OR 'fertility \npreservation' OR 'ovarian \ncryopreservation'/exp OR 'ovarian \ncryopreservation' OR \n'cryopreservation'/exp OR \ncryopreservation OR 'ovarian tissue \ncryopreservation'/exp OR 'ovarian \ntissue cryopreservation') \n675 \n \n3. Results \nWe retrieved 919 studies from the literature. After \ndeduplication, we retrieved 752 studies (Figure 1). We \nincluded 6 studies in the systematic review, including \nthree case reports, one retrospective study, one \nprospective study, and one cross\n-sectional study. Risks \nof bias for the case reports were medium  risk for \nDonnez et al (17)  and Harzif et al (18)  low risk for \nFabbri et al (19) cross sectional study by Garavaglia et \nal (20) had low bias risk, while retrospective study by \nLotz et al (21) had medium risk, and prospective study \nby Oktay and Oktem (22)  also had medium bias risk. \n\n353 Ovarian Cryopreservation \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \nThe summary of the included study is presented in \nTable 2. \n \nTable 2. Summary of Included Studies \nStudy Design Patients (n) Patient Age \nAge at \nTime of \nFreezing \nAge at Time \nof \nTransplantat\nion \nTransplantat\nion Site Result \n \nDonnez \net al (17) \nCase report 2 \nPatient A: 25 \nyo \nPatient B: 27 \nyo \nPatient A 25 \nyo \nPatient B: \n27 yo \nPatient A 25 \nyo \nPatient B 27 \nyo \nOrthotopic \n(pelvic \nperitoneal \nwindow) \nTwo patients \nwith \nendometriosis \nwho should \nundergo \noophorectomy \nhad their \novarian cortex \ntissue \ncryopreserved\n. Subsequent \ngrafting of the \novarian tissue \northotopically \nresulted in \nvital ovarian \ntissue after \nthree months \nof follow-up. \nBoth patients \nhad no natural \npregnancy, \nbut ovarian \ntissue graft \nshows viable \nprimordial \nfollicles and \nnormal \novarian \nfunction \nHarzif et \nal (18) Case report 2 \nPatient A: 21 \nyo Patient B: \n21 yo \nPatient A: \n21 yo \nPatient B: \n21 yo \nN/A N/A \nTwo patients \nwith \nendometriosis \nunderwent \ncystectomy \nand ovarian \ncortex \ncryopreservati\non. Ovarian \ntissue was \nsuccessfully \nfrozen. No \novarian tissue \ngraft was \nreported in the \nstudy. \nFabbri et \nal \n(19) Case report 1 24 y.o 24 y.o \n1st \nTransplantatio\nn 34 yo \n2nd \nTransplantatio\nn 37 yo \n \n1st \ntransplantatio\nn: orthotopic \n(10 strip left \novary, 5 strips \nin the left \nperitoneal \npocket) \nOne patient \nwith cystic \nteratoma and \nendometriosis \nunderwent \novarian tissue \ncryopreservati\non before \nreceiving \ngonadotoxic \n\nAchmad Kemal Harzif et al. 354 \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \nStudy Design Patients (n) Patient Age \nAge at \nTime of \nFreezing \nAge at Time \nof \nTransplantat\nion \nTransplantat\nion Site Result \n2nd \ntransplantatio\nn: \nheterotopic \n(17 strips in \nthe small \npockets of the \nabdominal \nwall) \nchemotherapy\n. After \northotopic \nimplantation \nof frozen \novarian tissue, \nmenopausal \nsymptoms \ndisapeared, \nbut serum \nhormonal \nlevels \nremained at a \nmenopausal \nlevel. \nOktay \nand \nOktem \n(22) \nProspectiv\ne Study \n59 patients \nunderwent \novarian tissue \ncryopreservat\nion \n(only 3 had \novarian \ntransplantatio\nn and only 1 \nout of 3 had \nendometriosis \nMean age of \n59 patients \n26.7 ± 1.2 \nyears (range \n4–44 years). \n28 yo \n(patient \nwith \nendometrios\nis) \n29 yo (patient \nwith \nendometriosis\n) \northotopic \n(left pelvic \nperitoneum) \nThe study \nincluded \npatients with a \nrisk of \npremature \nmenopause \ndue to \ngonadotoxic \ntreatment and \ngonadectomy. \nOut of 59 \npatients, three \npatients had \ntheir ovarian \ntissue grafted \nafter \ntreatment. \nOne patient \nwith \nendometriosis \nhad ovarian \nfunction only \nfor nine \nmonths and \nno \nspontaneous \npregnancy. \nGaravagl\nia et al \n(20) \nCross \nSectional \nstudy \n202 (patients \nwith \nendometriosis\n) \n400 (control) \nMean age \n34.7 ± 5.9 ye\nars (range \n19–48 age \nyears) \nN/A N/A N/A \nIn patients \nwith \nendometriosis \nwho are \ncandidates for \novarian tissue \ncryopreservati\non, anti-\nmullerian \nhormone is a \nreliable \npredictor of \nfollicular \ndensity. \nLower AMH \nlevel \ncorresponded \nto the lower \nnumber of \n\n355 Ovarian Cryopreservation \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \nStudy Design Patients (n) Patient Age \nAge at \nTime of \nFreezing \nAge at Time \nof \nTransplantat\nion \nTransplantat\nion Site Result \nprimordial \nfollicle \nLotz et al \n(21) \nRetrospecti\nve study 17 \nMean age \n29.5±6.3 \nyears (14-39 \nyears). \nMean age \n29.5±6.3 \nyears (14-\n39 years) \nMean age \n34.6± 4.3 \nyears (28-40 \nyears) \nOrthotopic \n(peritoneal \npocket of the \npelvic \nperitoneum in \nthe ovarian \nfossa) \nEndometriosis \npatients \nundergoing \novarian tissue \ncryopreservati\non. Before \novarian tissue \ntransplantatio\nn, none of the \npatients \nconceived \nspontaneously\n. After \ntransplantatio\nn, seven \n(41.2%) \nbecame \npregnant, with \nthree \nspontaneous \nconception \nand four \nnatural IVF \ncycles. \nyo = years old, N/A = not available \n \n \nFigure 1. PRISMA Diagram. Firstly, 919 studies were retrieved, and 752 were retrieved after deduplication. Finally, only \nsix studies were included. \n\n\nAchmad Kemal Harzif et al. 356 \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \n4. Discussion \nThe present systematic review is purposed to \nsummarize the evidence on ovarian tis sue \ncryopreservation in endometriosis patients. Case \nreports on ovarian tissue cryopreservation show that \novarian tissue cryopreservation is a viable method to \npreserve ovarian function after genotoxic treatment or \ngonadectomy. However, the case reports di d not show \nany outcome on fertility.  \nOvarian tissue cryopreservation is a fertility \npreservation method that includes  freezing ovarian \ntissues and grafting them at a later time, preferably \nafter cessation of genotoxic treatment Ladanyi et al \n(23). The majority of cases in which ovarian tissue was \ncryopreserved are in prepubertal patients wh o had \nmalignancy and had to undergo genotoxic \nchemotherapy or radiotherapy. Given the limitation of \novarian stimulation in prepubertal patients, ovarian \ntissue cryopreservation remains the most promising \noption (24). Ovarian tissue cryopreservation has  been \nshown to induce puberty and result in normal endocrine \nfunction in these patients (23, 25, 26). \nThere are several advantages of ovarian tissue \ncryopreservation compared to other fertility-preserving \nmethods. Firstly, ovarian tissue cryopreservation does \nnot require follicle stimulation, which takes time and \ncould delay treatment. In patients with coexisting \naggressive cancer or large endometrioma, follicle \nstimulation might delay treatment, which might worsen \nthe prognosis of these patients. Secondly, ovarian \ntissue cryopreservation is the only fertility preservation \nmethod in prepubertal girls. Finally, ovarian tissue \ncryopreservation could preserve not only fertility b ut \nalso ovarian endocrine function, which minimizes the \nrequirement for long- term hormone supplementation \n(27, 28).  \nHowever, the research by Oktay and Oktem (22)  \nshows that cryopreserved tissue grafting is still \nunderutilized. Only 3 out of 59 patients who underwent \novarian tissue cryopreservation eventually underwent \ngrafting. This reveals that this technique is still needing \nto be utilized despite its benefits. Additionally, ovarian \ntissue cryopreservation is still considered an \nexperimental method, whic h means the evidence \naround ovarian tissue cryopreservation still lack (23, \n29).  \nIt must be considered that endometriosis affects the \novarian tissue in most cases. Fabbri et al (19)  \nconducted a study that showed that a patient who \nunderwent surgical excision for ovarian endometriosis \nmight experience a negative impact on ovarian reserve \n(19). This was evident from the high degree of damage \nin the ovarian tissue, with loss of stromal compartment \nand structural organization and presence of fibrotic \nareas in both fresh and thawed ovarian tissue. In \nanother study by Harzif et al (18) , it was reported that \nthe density of the follicle was lower in endometriosis \npatients than in normal ovarian tissue, which is a \npossible cause for low ovarian reserve. This correlates \nwith the study that ovarian endometriosis cysts \npromote an inflammatory reaction causing fibrosis \nsurrounding the normal ovarian cortex, which is \nassociated with concomitant loss of cortex and reduced \nfollicular density (30, 31) . The fluid contained in the \nendometriosis cysts, which is enriched with cellular \ndamage mediating factors, may cause oocyte apoptosis \nand necrosis in primordial follicles. Thus, the follicles \nthat are very close to the endometrioma wall could be \naltered (31, 32). In a case report by Donnez et al (17) a \npatient with left endometrioma who had undergone two \nlaparotomies showed compromised ovarian \nvascularization before transplantation. This correlates \nto a potential mechanism of surgery -related local \ninflammation and vascular damage  due to \nelectrosurgical coagulation during hemostasis that may \nhave an impact on ovarian function (33, 34). \nOnly one study stated no signs of endometriosis \ncould be detected in any women by ultrasound after \novarian tissue transplantation (21) . The other studies \ndid not mention the progression of endometriosis after \ntransplantation. \nOne study by Garavaglia et al (20)  shows that \nAntimüllerian hormone (AMH) level is associated with \nprimordial follicle count. Ovarian tissue \ncryopreservation is highly dependent on the number of \nfollicles in the removed ovarian strips, and  the AMH \nlevel should be tested before offering the option for \novarian tissue cryopreservation.  A case report by \nHarzif et al (18) also shows that patients with a serum \nAMH level of 7.2 ng/mL have an adequate follicle \ncount on ovarian biopsy, with 1.8 -166 follicles per \nmm\n3 of ovarian tissue. \nEndometriosis patients who already have low AMH \nlevels and subsequently low follicle counts also have a \nfaster follicle depletion rate; in this case, ovarian tissue \ncryopreservation might not be an effective fertility \npreservation method. A threshold value of 1.28ng/mL \nis a good indicator for sufficient immature oocytes, and \npatients with AMH levels below 1.28ng/mL should not \nbe offered ovarian tissue cryopreservation to avoid \nredundant surgery (20). However, there is no evidence \non the level of AMH on ovarian tissue cryopreservation \nsuccess, and further research is warranted. \nMost studies included in this systematic review use \northotropic grafting for ovarian tissue, meaning that the \ncryopreserved ovarian tissue is grafted in the remaining \novary, ovarian fossa, or broad ligament. Only one study \nconducted by Fabbri, Vicenti (19)  used a heterotopic \nmethod that was located in the subcutaneous space of \nthe abdomin al wall as the second attempt of \ntransplantation.  \nTwo studies, one by Donnez et al (17)  showed \novarian tissue viability was maintained and shown by \nthe presence of neovascularization and covered with \nliving endothelial cells, and another study by Fabbri e t \n\n357 Ovarian Cryopreservation \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \nal (19) showed small follicle growth after orthotropic \ntransplantation and t he disappearance of menopausal \nsymptoms was shown after 6 months of the second \ntransplantation using a heterotopic site. However, \nDonnez et al (17)  reported low follicle count an d the \npresence of fibrosis in one case 3 months after \northotropic transplantation located beneath the right \novarian hilus and close to the ovarian blood vessels, \nshowing that ovarian tissue viability after orthotropic \nimplantation could be poor. \nSeveral factors impact the vitality of ovarian tissue \nafter implantation. The c ryopreservation technique \nplays a significant role in the vitality of ovarian tissue. \nStudies have shown that the slow freezing protocol \nusing DMSO as a cryoprotectant resulted in better \nfollicle survival compared to using ethylene glycol as a \ncryoprotectant. The majority of children born after \nautotransplantation of ovarian cortical tissue that was \ncryopreserved using Dimethyl Sulfoxide (DMSO) as \ncryopectants (CPA) (35, 36). Additionally, heterotopic \nimplantation also provides a better vascular bed for the \nimplant, resulting in better vitality and more mature \noocytes (23). \nOvarian function after implantation appears to be \ngood. One study shows ovarian function in \nendometriosis patients returned to normal for at least \nnine months (22). \n In the case report by Fabbri et al (19) , it was \nobserved that although the symptoms of menopause \ndisappeared, the endocrine function was still lost, as \nshowed by the levels of FSH, LH, Progesterone, and \nEstrogen, which remained at menopausal levels even \nafter successful ovarian tissue grafting. The case \nincluded several other pathologies aside from \nendometriosis, namely cystic teratoma and stroma \novary. The pathologies result in worse ovarian function \nbefore extraction of ovarian tissue, which might impact \novarian tissue function after grafting. The existing \nliterature suggests that ovarian tissue cryopreservation \nresulted in lower ovarian endocrine function compared \nto other indications (19, 22). However, further research \nshould be conducted to study endocrine function in \nendometriosis patients undergoing ovarian tissue \ncryopreservation. \nThe result of the study shows that heterotopic \nimplantation resulted in more extended  ovarian \nfunction compared to orthotropi c implantation, as \npatients with heterotopic implantation had endocrine \nfunction for more than three years. However, Lotz et al \n(21) reported a good pregnancy rate  in endometriosis \npatients with orthotopic implantation.  Unfortunately, \nthe study did not ana lyze hormonal level s before and \nafter implantation.  \nThe p regnancy rate seems to be good in patients \nundergoing orthotopic implantation of ovarian tissue. \nIn one case by Donnez et al (17)  a patient was able to \nconceive after three IVF attempts, despite not being \nable to conceive naturally. Lotz et al (21) reported that \nout of the 17 women who underwent orthotopic \nimplantation, 7 (41.2%) became pregnant, with 3 of \nthem conceiving naturally (42.8%) and 4 (57.2%) \nconceiving through natural cycle IVF/ICSI. However, \nit is important to note that only one out of two patients \nwith endometriosis who underwent ovarian tissue \nremoval for cryopreservation reported a successful \npregnancy but were unable to carry it to term.  \nThis result is in accordance to the previous result by \nJensen et al (37) , showing that ovarian tissue \ncryopreservation resulted in good pregnancy rate and \nlive births. Additionally, the perinatal outcome is also \ngood in patients unde rgoing ovarian tissue \ncryopreservation. Unfortunately, there is no research \non perinatal outcome s in endometriosis patients \nundergoing ovarian tissue cryopreservation. \n \n5. Conclusion \nOvarian tissue cryopreservation is a viable fertility \npreservation technique for endometriosis patients who \nare at risk of premature ovarian insufficiency or require \ngonadectomy. While the current evidence suggests \ngood endocrine function and fertility in these patients, \nmore research is needed to determine the long -term \noutcomes. \n \n6. Declarations \nAcknowledgments \nNot applicable. \n \nEthical Considerations \nThis study was approved by the Ethics and Research \nCommittee of the Faculty of Medicine Universitas \nIndonesia, under registration number: KET -\n1292/UN2.F1/ETIK/PPM.00.02/2023, and protocol \nnumber: 23-09-1467. \n \nAuthors' Contributions \nA.H., M.M., contributed to the search strategy, \nresearch design of the systematic review, and aided in \ndata analysis. C.R. and S.P. were responsible for \ndrafting the manuscript and conducting article \nscreening. H.M., N.U., and A.P., thoroughly revised \nthe manuscript for significant intellectual content and \ngranted approval for the final version to be published. \nB.W. oversaw the study and provided important \nintellectual content revisions for the manuscrip t. All \nauthors have reviewed the manuscript and given their \napproval for publication. \n \nConflict of Interest \nThe authors declare no conflict of interest. \n \n\nAchmad Kemal Harzif et al. 358 \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \nFund or Financial Support \nThis research received no specific grant from any \nfunding agency in the public, commercial, or not for \nprofit sector. \n \n \n \n1. Parasar P, Ozcan P, Terry KL. Endometriosis: \nEpidemiology, Diagnosis and Clinical \nManagement. Curr Obstet Gynecol Rep. 2017;  \n6(1):34-41. [ DOI:10.1007/s13669-017-0187-1] \n[PMID] [PMCID] \n2. Chauhan S, More A, Chauhan V, Kathane A. \nEndometriosis: A Review of Clinical Diagnosis, \nTreatment, and Pathogenesis. Cureus. 2022;  \n14(9):e28864. [DOI:10.7759/cureus.28864] \n3. Horne AW , Missmer SA. Pathophysiology, \ndiagnosis, and management of endometriosis. \nBMJ. 2022;379:e070750. [PMID]  \n[DOI:10.1136/bmj-2022-070750]  \n4. 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Jensen AK, Macklon KT, Fedder J, Ernst E, \nHumaidan P, Andersen CY. 86 successful births \nand 9 ongoing pregnancies worldwide in women \ntransplanted with frozen -thawed ovarian tissue: \nfocus on birth and perinatal outcome in 40 of \n\nAchmad Kemal Harzif et al. 360 \n      Volume 10, May 2025       Journal of Obstetrics, Gynecology and Cancer Research \nthese children. J Assist Reprod Genet. 2017;  \n34(3):325-36. [ DOI:10.1007/s10815-016 -0843-\n9] [DOI:10.1007/s10815-017-0873-y] [PMCID] \n \n \nHow to Cite This Article:  \nHarzif, A. Kemal, Maidarti, M., Rumapea, C. Tryono Parulian, Pratamasari, S. , et  al. Ovarian Tissue \nCryopreservation in Patients with Endometriosis: A Systematic Review of the Literature. J Obstet Gynecol Cancer \nRes. 2025;10(5):351-60. \nDownload citation:                             RIS | EndNote | Mendeley |BibTeX |","source_license":"CC0","license_restricted":false}