Introduction In-vitro culture systems for ovarian follicles are enabling tools for advancing the study of folliculogenesis and the development of fertility preservation techniques. Folliculogenesis is a complex process regulated by endocrine, paracrine and autocrine factors, and can be difficult to study in vivo. In-vitro culture systems provide a controlled environment in which to investigate the mechanisms driving follicle development. The usage of these systems has produced significant discoveries about the influence of hormones, mechanics and extracellular matrix (ECM) proteins in folliculogenesis [1–6]. In addition to these fundamental observations, these culture systems are providing a foundation for the development of systems for fertility preservation for cancer survivors [7, 8]. The increase in survival rates for young women with cancer has prompted the need for fertility preservation techniques . Life-saving cancer treatments, such as chemotherapy and radiation, threaten fertility by diminishing the immature follicle pool and triggering early menopause. Current treatments include cryopreservation and transplantation of ovarian tissue, which incurs the risk of re-introducing cancer cells into the patient [10, 11]. The successful development of follicle culture systems could circumvent this risk, by allowing in vitro follicle maturation/fertilization to obtain fertilizable oocytes from immature follicles. Follicle culture systems have had some success; however, further developments are necessary to achieve the consistent growth of human follicles to produce fertilizable oocytes [12, 13]. Stromal tissue is essential for the development of the earliest stage follicles. The ovarian stroma contains interstitial–theca cells, neurons, blood vessels and macrophages.
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