Seli Emre, Tangir Jacob
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
Curr Opin Obstet Gynecol. 2005 Jun;17(3):299-308. doi: 10.1097/01.gco.0000169108.15623.34.
Preservation of fertility in female patients diagnosed with cancer has recently been an area of intensive investigation. This review summarizes available options and discusses recently published data concerning experimental methods. Specific strategies for fertility preservation in women with gynecologic malignancies are also presented.
Success with ovarian stimulation protocols using tamoxifen or aromatase inhibitors has recently been reported for women with breast cancer who attempt embryo cryopreservation prior to chemotherapy. The first embryo transfer using oocytes retrieved from cryopreserved ovarian tissue implanted at a heterotopic location, the first pregnancy following orthotopic transplantation of cryopreserved ovarian tissue, and increasing success with oocyte cryopreservation were also reported.
Fertility preservation in female patients with cancer has become an important health issue due to increasing survival rates and delayed childbearing especially in Western countries. Radical vaginal trachelectomy for cervical cancer, conservative surgery for ovarian tumors, and progestin treatment in endometrial cancers may be considered at early stages in order to preserve fertility. Embryo cryopreservation is an established technique that is available for fertility preservation, providing a delay in the initiation of chemotherapy or radiotherapy is acceptable, and a partner or donor sperm is available. Additional techniques that could be offered after counseling the patient about their experimental nature include oocyte cryopreservation, ovarian cryopreservation, and gonadotropin-releasing hormone agonist co-treatment with chemotherapy. Improvement of these techniques as well as better characterization of their success rates and risks await further investigation.
对于被诊断患有癌症的女性患者，保留生育能力近来一直是深入研究的领域。本综述总结了现有的选择，并讨论了有关实验方法的最新发表数据。还介绍了妇科恶性肿瘤女性患者保留生育能力的具体策略。
最近有报道称，对于在化疗前尝试进行胚胎冷冻保存的乳腺癌女性患者，使用他莫昔芬或芳香化酶抑制剂的卵巢刺激方案取得了成功。还报道了首次使用从异位植入的冷冻卵巢组织中获取的卵母细胞进行胚胎移植、冷冻卵巢组织原位移植后的首次妊娠以及卵母细胞冷冻保存成功率的提高。
由于生存率提高和生育延迟，尤其是在西方国家，癌症女性患者的生育力保留已成为一个重要的健康问题。早期可考虑对宫颈癌行根治性阴道子宫切除术、对卵巢肿瘤行保守性手术以及对子宫内膜癌进行孕激素治疗以保留生育能力。胚胎冷冻保存是一种成熟的生育力保留技术，前提是化疗或放疗的开始延迟是可接受的，并且有伴侣或供体精子可用。在向患者咨询其实验性质后可提供的其他技术包括卵母细胞冷冻保存、卵巢冷冻保存以及促性腺激素释放激素激动剂与化疗联合治疗。这些技术的改进以及对其成功率和风险的更好描述有待进一步研究。
