This chapter focuses on female fertility preservation procedures because of their complexity and peculiarities. Ovarian failure leads to the impossibility of childbearing apart from other problems related to the menopause, such as vasomotor, skeletal or cardiovascular alterations. Early menopause and infertility are two of the main consequences for patients treated with gonadotoxic agents. Gonadotoxicity, a decrease in ovarian activity, depends on several factors, including the age of the patient; the initial status of the ovaries; the treatment applied and cumulative doses; and the type of agent used. Ovarian tissue freezing for later autotransplantation is alternative for fertility preservation in women with oncological or non-oncological diseases. Any patient with a high risk of premature ovarian failure is a possible candidate for fertility preservation. Oocyte and ovarian tissue cryopreservation are useful as they overcome some of the disadvantages, ethical concerns and legal restrictions related to embryo cryopreservation.

Cytogenetic abnormalities of the human oocyte, as described by Pellestor, are remarkably common and there appears to be a multifactorial effect of maternal ageing. Aneuploid embryos are common following in vitro fertilization (IVF), even in unstimulated cycles. Egg freezing has proved to be technically much more difficult than embryo freezing. Ovarian failure is an untreatable condition but the opportunity for pregnancy can be restored by egg donation. Success rates are high and are maintained with increasing age. If the uterus cannot support a pregnancy, for example because of fibroids, or if the potential mother is too unfit for pregnancy, surrogacy will be required. In reviewing the uses of assisted reproduction, some 'abuses' have been revealed. The infertile couples seeking help can be desperate for treatment and therefore be vulnerable to suggestion. Reproductive tourism is burgeoning, driven by women's needs for treatment but also by commercial interests.

This chapter describes the psychiatric disorders of menses, pregnancy, postpartum and menopause in women. An understanding of hormonal influences on mood is important in trying to tie together those women who appear to be an increased risk of depression premenstrually, postnatally and at menopause. Maternal anxiety and depression in pregnancy may have particular effects on the foetus. A woman suffering from premenstual dysphoric disorder (PMDD) must experience at least five premenstrual symptoms and functional impairment due to the symptoms. Women in the Western world are living longer and are consequently spending more of their lives postmenopause. Oestrogen therapy has also been used in the management of psychological/ psychiatric and cognitive symptoms associated with the menopause. However, it has been argued that these symptoms may be more related to comorbid physical and psychosocial factors rather than the effects of ovarian failure.

To women traditionally considered irreversibly sterile due to ovarian failure, oocyte donation and exogenous steroid replacement offers the prospect of achieving a successful pregnancy. Women requiring oocyte donation comprise two main groups: women with primary or secondary ovarian failure, and women with normal menstrual cycles. There will always be an imbalance between supply of and demand for donated oocytes due to ethical considerations. Women of ethnic origin groups must be screened for haemoglobin electrophoresis, sickle cell and Tay-Sachs disease. Adequate and sustained steroid hormone secretion by the corpus luteum of the ovulatory cycle is required for establishing and maintaining pregnancy in humans for the first seven to nine weeks. This chapter discusses oestrogen replacement, progesterone replacement, replacement protocols, oocyte donation in menstrually cyclic recipients, and implantation window. As average life expectancy and quality of life increase, pregnancy from oocyte donation to post-menopausal women becomes more possible.