Revel Ariel, Schenker Joseph
Department of Gynecology, Hadassah University Hospital, Kiryat hadassah, POB 12000 Jerusalem, Israel.
Hum Reprod. 2004 Jan;19(1):14-9. doi: 10.1093/humrep/deh002.
The effect of chemotherapy and radiotherapy on future fertility is of concern to patients and their families. Whereas sperm banking is commonly performed, female gametes are not so amenable to cryopreservation. One alternative includes postponing cancer treatment to enable ovulation induction and oocyte aspiration. Whenever possible, retrieved oocytes should be fertilized in vitro prior to cryopreservation. Frozen embryos could serve to produce pregnancies if ovarian failure occurs. Donor sperm can be offered to single patients, as frozen-thawed unfertilized oocytes yield poor pregnancy rates. Ovarian cortex cryopreservation should still be considered an experimental technology as no pregnancies have been obtained in humans. Therefore, ovarian cortex banking should be used only for young girls, adolescents and when IVF is contraindicated. Reattachment of ovarian vasculature could prevent ischaemic follicular loss and enable ovarian transplantation in the future. This procedure is currently under investigation in animals. At the present time, we recommend urgent IVF in most patients requesting fertility preservation. Ovarian cryopreservation should be offered when emergency IVF is not possible.
化疗和放疗对未来生育能力的影响是患者及其家属所关心的问题。虽然精子冷冻保存很常见，但女性配子不太适合冷冻保存。一种替代方法是推迟癌症治疗，以便进行促排卵和卵母细胞抽吸。只要有可能，回收的卵母细胞应在冷冻保存前进行体外受精。如果发生卵巢功能衰竭，冷冻胚胎可用于实现妊娠。对于单身患者可提供供体精子，因为冻融未受精卵母细胞的妊娠率较低。卵巢皮质冷冻保存仍应被视为一项实验技术，因为尚未在人类身上实现妊娠。因此，卵巢皮质冷冻保存仅应用于年轻女孩、青少年以及体外受精禁忌的情况。卵巢血管的重新连接可以防止缺血性卵泡丢失，并在未来实现卵巢移植。该手术目前正在动物身上进行研究。目前，我们建议大多数要求保留生育能力的患者进行紧急体外受精。当无法进行紧急体外受精时，应提供卵巢冷冻保存。
