Bedaiwy Mohamed A, El-Nashar Sherif A, El Saman Ali M, Evers Johannes L H, Sandadi Samith, Desai Nina, Falcone Tommaso
Department of Gynecology and Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Hum Reprod. 2008 Dec;23(12):2709-17. doi: 10.1093/humrep/den301. Epub 2008 Aug 9.
Despite interest in ovarian tissue transplantation (OTT) as a promising procedure for fertility preservation, to date, no precise data are available about its effectiveness. We systematically reviewed reproductive function after OTT for fertility preservation in women at high risk of premature ovarian failure (POF).
We searched the MEDLINE, EMBASE, Cochrane Systematic Reviews, CENTRAL, Web of Science and Scopus databases for studies on the reproductive outcomes after OTT in humans up to June 2007. Women with follicle-stimulating hormone (FSH) >30 IU/l at the time of OTT were included in a meta-analysis of individual-patient data to evaluate the time to re-establishment of ovarian function (ROF). Secondary outcomes included short-term (<12 months) and long-term (>12 months) ovarian function (OVF) and pregnancy after OTT.
We identified 25 reports including 46 unique cases. OTT was performed to treat POF in 27 women, to prevent POF in 15, to treat infertility in 2 and accidentally in 1. In 23 women with FSH >30 at the time of OTT, OVF was re-established with a median time to ROF of 120 days (range 60-244). Within 6 months after ROF, four women had recurrent ovarian failure. There are insufficient data to evaluate the long-term OVF (>12 months). Fresh grafts had an increased likelihood of return of OVF and a decreased likelihood for recurrent ovarian failure compared with cryopreserved grafts [HR of 2.44 (95% CI 0.92, 6.49) and 0.47 (95% CI 0.18, 1.12), respectively]. In 25 women who sought pregnancy, eight women had nine pregnancies at 12 months, giving a cumulative pregnancy rate of 37% (95% CI 19, 60).
Transplantation of ovarian tissue can re-establish OVF after POF; however, the efficacy of OTT using cryopreserved tissues is not yet equivalent to that of fresh grafts. A controlled multicenter trial with sufficient follow-up would provide valid evidence of the potential benefit of this procedure.
尽管卵巢组织移植（OTT）作为一种有前景的生育力保存方法备受关注，但迄今为止，尚无关于其有效性的确切数据。我们系统回顾了卵巢组织移植用于高危卵巢早衰（POF）女性生育力保存后的生殖功能。
我们检索了MEDLINE、EMBASE、Cochrane系统评价、CENTRAL、科学引文索引和Scopus数据库，以查找截至2007年6月关于人类卵巢组织移植后生殖结局的研究。在卵巢组织移植时促卵泡激素（FSH）>30 IU/L的女性被纳入个体患者数据的荟萃分析，以评估恢复卵巢功能（ROF）的时间。次要结局包括短期（<12个月）和长期（>12个月）卵巢功能（OVF）以及卵巢组织移植后的妊娠情况。
我们确定了25篇报告，包括46例独特病例。进行卵巢组织移植治疗POF的有27例女性，预防POF的有15例，治疗不孕症的有2例，意外情况1例。在23例卵巢组织移植时FSH>30的女性中，恢复了卵巢功能，恢复卵巢功能的中位时间为120天（范围60 - 244天）。恢复卵巢功能后6个月内，4例女性出现复发性卵巢功能衰竭。尚无足够数据评估长期卵巢功能（>12个月）。与冷冻保存的移植物相比，新鲜移植物恢复卵巢功能的可能性增加，复发性卵巢功能衰竭的可能性降低[风险比分别为2.44（95%可信区间0.92，6.49）和0.47（95%可信区间0.18，1.12）]。在25例寻求妊娠的女性中，8例女性在12个月时有9次妊娠，累积妊娠率为37%（95%可信区间19，60）。
卵巢组织移植可在卵巢早衰后恢复卵巢功能；然而，使用冷冻保存组织的卵巢组织移植效果尚不及新鲜移植物。一项有充分随访的对照多中心试验将为该手术的潜在益处提供有效证据。
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