Lutchman Singh Kerryn, Davies Melanie, Chatterjee Ratna
Department of Obstetrics and Gynaecology, Reproductive Medicine Unit, Elizabeth Garrett Anderson and Obstetric Hospital, University College London Hospital, Huntley Street, London WC1E 6DH, UK.
Hum Reprod Update. 2005 Jan-Feb;11(1):69-89. doi: 10.1093/humupd/dmh052. Epub 2004 Nov 29.
The improved long-term survival of adolescents and young women treated for cancer has resulted in an increased focus on the effects of chemotherapy on ovarian function and its preservation. These women may seek advice and treatment regarding their reproductive status, including ways of preserving their fertility and preventing a premature menopause--factors that can have a profound impact on their quality of life. This article comprehensively reviews ovarian reserve testing (ORT) in general. Special emphasis is placed on patients with cancer, including the pathophysiology of gonadal damage following chemotherapy, fertility preservation and the potential role of ORT. Baseline parameters of ovarian reserve [FSH LH, estradiol, inhibin B and anti-Mullerian hormone (AMH)] have not yet performed sufficiently well in predicting poor outcome in assisted reproduction, but biochemical markers of ovarian reserve appear to be better than chronological age. Inhibin B and AMH show potential for future use. Dynamic testing appears to show much promise, especially stimulated levels of inhibin B and estradiol. The most promising tests of ovarian reserve are the biophysical markers, where total antral follicle count was found to be most discriminatory followed by ovarian volume. Combination of biochemical, biophysical and clinical markers of ovarian reserve may also improve predictive capacity. However, there is a lack of data pertinent to ORT in cancer. As yet there is no single clinically useful test to predict ovarian reserve accurately. Patients with cancer represent a distinct cohort who have particular concerns about their future fertility and the possibility of a premature menopause, they can benefit greatly from knowledge of their functional ovarian reserve. Large, prospective, randomized, adequately controlled studies specific to different geographical areas are required in a control population of comparable reproductive age to determine the potential role of ORT in clinical practice.
接受癌症治疗的青少年和年轻女性长期生存率的提高，使得人们更加关注化疗对卵巢功能及其保护的影响。这些女性可能会就其生殖状况寻求建议和治疗，包括保留生育能力和预防过早绝经的方法——这些因素会对她们的生活质量产生深远影响。本文全面综述了一般的卵巢储备功能检测（ORT）。特别强调了癌症患者，包括化疗后性腺损伤的病理生理学、生育力保护以及ORT的潜在作用。卵巢储备的基线参数[促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇、抑制素B和抗苗勒管激素（AMH）]在预测辅助生殖不良结局方面尚未表现得足够出色，但卵巢储备的生化标志物似乎比实际年龄更具优势。抑制素B和AMH显示出未来应用的潜力。动态检测似乎很有前景，尤其是抑制素B和雌二醇的刺激水平。最有前景的卵巢储备功能检测是生物物理标志物，其中发现窦卵泡总数的鉴别能力最强，其次是卵巢体积。卵巢储备的生化、生物物理和临床标志物相结合也可能提高预测能力。然而，缺乏与癌症患者ORT相关的数据。目前还没有一种临床上有用的检测方法能够准确预测卵巢储备功能。癌症患者是一个特殊的群体，他们特别关注自己未来的生育能力和过早绝经的可能性，了解其功能性卵巢储备情况会使他们受益匪浅。需要在具有可比生殖年龄的对照人群中开展针对不同地理区域的大型、前瞻性、随机、充分对照的研究，以确定ORT在临床实践中的潜在作用。
