Only About One in Ten Girls and Young Women Return for Ovarian Tissue Transplantation, Meta-Analysis Finds

Girls and young women who freeze ovarian tissue before cancer treatment rarely come back to use it, according to a systematic review and meta-analysis published in BMC Pregnancy and Childbirth. After screening 2,856 references, researchers identified 11 studies covering 447 patients—130 prepubertal and 317 pubertal—who had ovarian tissue cryopreserved for medical indications. The pooled return rate for transplantation was just 12 percent, meaning 31 of the 447 patients ultimately had their stored tissue transplanted back.

The review, registered with PROSPERO under code CRD420251107555, searched five databases—PubMed, Ovid Medline, Embase, the Cochrane Library, and Web of Science—for records published between January 1, 2004, and January 1, 2025. The authors included only original human studies reporting individual patient data on prepubertal and/or pubertal patients who underwent ovarian tissue cryopreservation and subsequent transplantation for medical reasons. Study screening and full-text review were performed independently by two reviewers, with disagreements resolved by consensus, and meta-analysis used a random-effects model to calculate pooled rates with 95 percent confidence intervals, with heterogeneity assessed using the I² statistic.

Ovarian tissue cryopreservation is a fertility preservation method that uses low-temperature freezing to store ovarian tissue. The authors note that previous studies have indicated significant discrepancies in both counseling approaches and expectations regarding anticipated thawing rates and reproductive outcomes in prepubertal patients—one of the motivations for pooling the available data.

Subgroup analysis showed that return rates were broadly similar across age groups: 13.0 percent for prepubertal patients and 17.0 percent for pubertal patients, a difference that was not statistically significant (P = 0.808). In other words, whether the tissue was frozen before or after puberty did not meaningfully change the likelihood that a patient would later return for transplantation within the studies analyzed.

Pregnancy outcomes told a more differentiated story. The pooled clinical pregnancy rate across all transplant recipients was 15 percent, but subgroup rates diverged: 3.0 percent for prepubertal patients compared with 25.0 percent for pubertal patients. Notably, all reported pregnancies resulted in live births.

Endocrine recovery was also documented. Among patients who received transplants, all demonstrated varying degrees of postoperative endocrine function recovery, indicating that reimplanted tissue can restore hormonal activity as well as contribute to fertility potential. The review did not report long-term stratified outcomes, and the authors explicitly state that evidence in this area is still evolving.

Taken together, the findings translate into a practical counseling message. Substantial cumulative clinical experience supports that approximately one-tenth of eligible patients return for ovarian tissue transplantation, and approximately one-sixth of those who undergo transplantation achieve successful live births.

The authors conclude that these results provide valuable evidence to inform fertility preservation decision-making and carry important implications for clinical counseling in this patient population.

Subject of Research: Return rates, pregnancy outcomes, and endocrine recovery after ovarian tissue cryopreservation and transplantation in prepubertal and pubertal patients

Article Title: Return rates, pregnancy, and endocrine recovery after ovarian tissue cryopreservation in prepubertal and pubertal patients: a systematic review and meta-analysis.

Article References: YanYan, Q., Jiahuan, L., RongQian, N., HuaWei, W., & Li, T. (2026). Return rates, pregnancy, and endocrine recovery after ovarian tissue cryopreservation in prepubertal and pubertal patients: a systematic review and meta-analysis.. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-026-08950-4

Image Credits: AI Generated

DOI: 10.1186/s12884-026-08950-4

Keywords: ovarian tissue cryopreservation, fertility preservation, prepubertal patients, pubertal patients, systematic review, meta-analysis, clinical pregnancy rate, endocrine recovery, live births, oncofertility, BMC Pregnancy and Childbirth, counseling