Safety assessment of autologous ovarian tissue cryopreservation and transplantation in cancer patients: an updated review.

Recently, the global incidence of malignant tumors has been increasing with a notable trend toward younger patients, representing a major public health challenge. Fertility preservation has emerged as a key issue at the intersection of oncology and reproductive medicine. Ovarian tissue cryopreservation and transplantation (OTCT) offers a unique and valuable strategy, particularly for prepubertal girls and patients requiring immediate gonadotoxic therapy. Although OTCT can effectively restore ovarian endocrine function and fertility, its clinical application is largely limited by safety concerns, especially the potential risk of reintroducing viable malignant cells via transplanted ovarian tissue. Therefore, accurate detection of minimal residual disease (MRD) in cryopreserved ovarian tissue and effective tumor cell decontamination strategies are essential to ensure clinical safety. In addition, long-term follow-up data on the health status of offspring born after OTCT remain insufficient. This narrative review systematically summarizes the safety concerns of OTCT, focusing on cancer-specific ovarian tissue contamination risks, current MRD detection and purging techniques, as well as the intergenerational safety of offspring. Based on recent evidence, this review can further provide key conclusions and practical recommendations for the safety assessment of OTCT, with the aim of promoting the safe, standardized, and widespread clinical application of this technique.