Pacey A A
Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Level 4, The Jessop Wing, Royal Hallamshire Hospital, Sheffield S10 2SF, UK.
Cancer Treat Rev. 2007 Nov;33(7):646-55. doi: 10.1016/j.ctrv.2007.02.001. Epub 2007 May 11.
Infertility is a common and distressing late-effect of cancer treatment. Whist sperm banking for post-pubertal males and embryo freezing for women (who are in a stable relationship at the time of treatment) are highly successful fertility preservation strategies, for females without a partner (including young and pre-pubescent girls) and pre-pubescent boys (or azoospermic men), there remain no effective approaches. Whilst the biological effects of cancer treatments on the reproductive system are well described, there are few data on the relative incidence of infertility (failure to conceive after one year of trying) in cancer survivors. This makes it difficult to advise survivors about their future fertility prospects. Whilst some will undoubtedly conceive naturally with their partner, others will require assisted conception treatment of which in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) are the most common. Pregnancy outcomes of cancer survivors are generally good, although there is increased risk of pre-term birth and low birth-weight in the offspring of women who have received pelvic irradiation. There is no increased incidence of genetic disease or cancer incidence in the offspring of cancer survivors. Current research directions are focussing on alternative fertility preservation strategies including in vitro maturation techniques, xenotransplantation and the development of technology to create artificial gametes in the laboratory. Finally, although the reproductive techniques discussed are highly effective, country specific differences in the legal framework means that cancer survivors may be denied access to certain treatments (e.g. embryo cryopreservation) because they are forbidden by specific national legislation.
不孕症是癌症治疗常见且令人苦恼的晚期效应。对于青春期后的男性进行精子库储存以及对于女性（在治疗时处于稳定关系）进行胚胎冷冻是非常成功的生育力保存策略，但对于没有伴侣的女性（包括年轻女孩和青春期前女孩）以及青春期前男孩（或无精子症男性），仍然没有有效的方法。虽然癌症治疗对生殖系统的生物学影响已有充分描述，但关于癌症幸存者中不孕症（尝试一年后仍未受孕）的相对发生率的数据却很少。这使得难以向幸存者提供关于他们未来生育前景的建议。虽然有些人无疑会与伴侣自然受孕，但其他人则需要辅助受孕治疗，其中体外受精（IVF）和卵胞浆内单精子注射（ICSI）是最常见的。癌症幸存者的妊娠结局总体良好，尽管接受盆腔放疗的女性所生后代早产和低出生体重的风险增加。癌症幸存者的后代中遗传疾病或癌症发病率没有增加。当前的研究方向集中在替代生育力保存策略上，包括体外成熟技术、异种移植以及在实验室中创造人工配子的技术开发。最后，尽管所讨论的生殖技术非常有效，但法律框架在国家层面的差异意味着癌症幸存者可能因特定国家立法禁止而无法获得某些治疗（例如胚胎冷冻保存）。
