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

Ovarian tissue cryopreservation is a fertility preservation method that utilizes low-temperature freezing technology to store ovarian tissue, serving as a crucial option for prepubertal girls requiring radiotherapy/chemotherapy and reproductive-aged women who cannot delay treatment. Previous studies have indicated significant discrepancies in both counseling approaches and expectations regarding anticipated thawing rates and reproductive outcomes following ovarian tissue cryopreservation in prepubertal patients. A systematic literature search was conducted across five databases (PubMed, Ovid Medline, Embase, the Cochrane Library, and Web of Science) for records published from January 1, 2004, to January 1, 2025. Original human studies reporting individual patient data on prepubertal and/or pubertal patients undergoing ovarian tissue cryopreservation and subsequent transplantation for medical indications were included. Study screening (title/abstract) and full-text review were performed independently by two reviewers, with discrepancies resolved through consensus. Data on return rates for transplantation, pregnancy outcomes, and endocrine function recovery were extracted. Meta-analysis was performed using a random-effects model to calculate pooled rates with 95% confidence intervals. Statistical heterogeneity was assessed using the I² statistic. After screening 2,856 references retrieved from database searches, 11 studies involving 447 patients (130 prepubertal, 317 pubertal) undergoing ovarian tissue cryopreservation were ultimately included in the meta-analysis. The overall pooled return rate for transplantation was 12% (31/447 patients). Subgroup analysis showed return rates of 13.0% for prepubertal and 17.0% for pubertal patients, with no statistically significant difference between subgroups ( P = 0.808). The pooled clinical pregnancy rate was 15%, with subgroup rates of 3.0% for prepubertal patients and 25.0% for pubertal patients, showing no significant difference ( P = 0.384). All pregnancies resulted in live births, and all transplant recipients demonstrated varying degrees of postoperative endocrine function recovery. While evidence regarding long-term stratified outcomes is still evolving, substantial cumulative clinical experience supports that approximately one-tenth of eligible patients return for ovarian tissue transplantation, with approximately one-sixth achieving successful live births. These findings provide valuable evidence to inform fertility preservation decision-making and carry important implications for clinical counseling in this patient population. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration code CRD420251107555.