Table 1.

Treatment options for fertility preservation.

Technique	Definition	Advantages	Disadvantages	Experimental
Oocyte cryopreservation	Controlled ovarian stimulation, followed by oocyte retrieval and cryoconservation for future use	- well-established fertility preservation technique - no ethical issues	- time required for ovarian stimulation - risk of overstimulation - invasive procedure for oocyte retrieval (day surgery) - not recommended in women with hormone-sensitive cancers - not possible for prepubertal girls - need of a male partner/donor for oocyte fertilization prior to implantation - high cost	No
Embryo cryopreservation	Controlled ovarian stimulation, followed by oocyte retrieval, in vitro fertilization and embryo cryopreservation for future use (19, 20).	- well-established fertility preservation technique - good embryo survival to thawing - direct transfer into the uterus after thawing	- ethical issues regarding embryo disposition - time required for ovarian stimulation and subsequent delay in timely cancer treatment - risk of overstimulation - invasive procedure for oocyte retrieval (day surgery) - not recommended in women with hormone-sensitive cancers - not possible for prepubertal girls - need of a male partner/donor - high cost	No*
Ovarian Tissue cryopreservation	Surgical retrieval of ovarian tissue, cryopreservation of the tissue and subsequent reimplantation once patient is disease-free	- feasible for prepubertal children - does not require hormonal stimulation - can be planned shortly after diagnosis of malignant disease	- surgical procedure under general anesthesia - risk of the re-introduction of carcinogenic cells - risk of malignant transformation of the ovarian tissue - risk of ischemic damage to the tissue - limited availability of centers with adequate cryoconservation competences and able to perform the most sensitive and updated histological analysis techniques before transplantation to avoid relapses - high cost	Yes
Ovarian suppression with GnRHa	Concomitant use of gonadotropin-releasing hormone analogs (triptorelin, goserelin, leuprolide) during the course of chemotherapy to induce a prepubertal hormonal milieu and preserve the ovarian function	- not invasive - does not need delaying in oncologic therapy - can be used in association with cryopreservation techniques - reduce the risk of hypermenorrhea associated with hematologic malignancies or myelosuppressive treatments - low cost	- symptoms of estrogenic deprivation - transient alterations of bone metabolism not significant for therapy duration < 6 months - limited clinical evidences in patients with disease other than breast cancer	Yes**

*Forbidden in Italy (Law 40/2003); **Reimbursed in Italy for oncologic adult patients according to Law 648/96.