Ovarian Tissue Cryopreservation in Turner Syndrome: A Narrative Review

Turner syndrome, caused by complete or partial monosomy X, leads to gonadal dysgenesis and accelerated follicular atresia, resulting in premature ovarian insufficiency in over 95% of affected individuals. Ovarian tissue cryopreservation (OTC) has emerged as a potential fertility preservation strategy, particularly for prepubertal girls ineligible for ovarian stimulation. Predictors of residual fertility include mosaic karyotype, higher anti-Müllerian hormone and inhibin B levels, lower FSH, evidence of pubertal development, and ultrasonographically visible ovaries, though cryptic gonadal mosaicism may obscure true reproductive potential. While donor oocyte IVF remains the most effective route to pregnancy, autologous oocyte cryopreservation is feasible in selected postpubertal patients, and OTC offers the advantage of earlier intervention without requiring hormonal stimulation. The procedure involves laparoscopic oophorectomy, cortical tissue preparation, cryopreservation, and subsequent reimplantation, with the possibility of preserving not only fertility but also endocrine function and natural pubertal development. However, ovarian tissue in Turner syndrome frequently demonstrates poor follicular morphology and reduced reserve, and significant limitations remain, including premature follicular depletion, technical challenges in tissue processing, suboptimal revascularization after transplantation, and uncertain functional restoration. Psychological and ethical considerations further complicate decision-making, particularly in young patients. Prospective studies such as Turner Fertility support procedural feasibility, yet live birth outcomes remain rare. Overall, OTC may represent a meaningful fertility preservation option in carefully selected individuals with Turner syndrome, but current evidence is limited and individualized, multidisciplinary counselling is essential to align interventions with realistic expectations.