Yifan Chu, Jialiang Zhang, Luyao Wang, Jiaxin Xie, Jiayun Chen, Xinyao Hu, Juepu Zhou, Ruolin Mao, Yan Miao, Yue Jing
The incidence of early-onset malignancies in reproductive-aged women is rising, necessitating effective fertility preservation strategies. Ovarian tissue cryopreservation (OTC) remains the sole option for prepubertal girls and patients requiring urgent oncologic treatment. However, post-transplant follicular attrition-driven by ischemia-reperfusion injury, oxidative stress, and aberrant primordial follicle activation-remains a major barrier. This comprehensive review elucidates the multiscale mechanisms of cryopreservation-induced follicular damage and evaluates cutting-edge strategies, including antifreeze protein-engineered cryoprotectants, angiogenesis-modulating scaffolds, and mTOR pathway inhibition. By integrating recent advances in biomaterial science and cryobiology, this study provides actionable insights to enhance OTC clinical efficacy and advance reproductive medicine.