Institute for Fertility Preservation, Rye, New York 10580, USA.
Oncologist. 2012;17(11):1409-17. doi: 10.1634/theoncologist.2012-0236. Epub 2012 Sep 24.
Women with breast cancer face many challenges when considering fertility preservation. Delayed referral results in the limitation of fertility preservation options because most established methods, such as embryo and oocyte cryopreservation, require several weeks to complete. Women with BRCA mutations, on the other hand, may be more aware of fertility issues and motivated to see fertility preservation specialists earlier. Fear of exposure to estrogen limits access to fertility preservation via embryo or oocyte cryopreservation; however, the use of aromatase inhibitors as ovarian stimulants reduces such concern. Ovarian cryopreservation can be used when there is insufficient time to perform ovarian stimulation because this technique does not require hormonal stimulation, but there are safety concerns both in women with BRCA mutations and in patients with hormone receptor-positive disease as well. There does not seem to be a proven ovarian suppression strategy to preserve fertility in women with breast cancer. Pregnancy appears to be safe for breast cancer survivors but studies specific for women with BRCA mutations are lacking. Women with BRCA mutations may elect to use preimplantation genetic diagnosis during in vitro fertilization to avoid transmitting the mutation, but there may be psychosocial difficulties in entertaining this option. Overall, the last decade has brought many options for women with breast cancer considering fertility preservation, but numerous challenges remain. The presence of BRCA mutations further contributes to these challenges.
患有乳腺癌的女性在考虑生育力保存时面临许多挑战。延迟转诊会限制生育力保存的选择，因为大多数已建立的方法，如胚胎和卵母细胞冷冻保存，需要数周时间才能完成。另一方面，携带 BRCA 突变的女性可能更了解生育问题，并更有动力尽早咨询生育力保存专家。对暴露于雌激素的恐惧限制了通过胚胎或卵母细胞冷冻保存来获得生育力保存的机会；然而，使用芳香化酶抑制剂作为卵巢刺激剂可以减少这种担忧。当没有足够的时间进行卵巢刺激时，可以使用卵巢冷冻保存，因为这种技术不需要激素刺激，但在携带 BRCA 突变的女性和激素受体阳性疾病的患者中都存在安全问题。似乎没有经过验证的卵巢抑制策略可以在患有乳腺癌的女性中保留生育力。妊娠对乳腺癌幸存者似乎是安全的，但缺乏针对携带 BRCA 突变的女性的研究。携带 BRCA 突变的女性可能会选择在体外受精期间使用胚胎植入前遗传学诊断来避免传递突变，但接受这种选择可能会存在心理社会困难。总的来说，过去十年为考虑生育力保存的乳腺癌女性带来了许多选择，但仍存在许多挑战。BRCA 突变的存在进一步加剧了这些挑战。
