The Fertility Clinic, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Reprod Biomed Online. 2013 Aug;27(2):192-200. doi: 10.1016/j.rbmo.2013.04.003. Epub 2013 Apr 18.
Previously, this study group found that female childhood cancer survivors could be at risk of early cessation of fertility. The aim of the present study was to evaluate reproductive function in the same group of survivors 10 years after the initial study. Of the original cohort of 100, 71 were re-examined. Thirty-six survivors reported regular menstrual cycles. When they were compared with 210 controls, they differed significantly in antral follicle count (AFC) (median 15 versus 18, P=0.047) but not in anti-Müllerian hormone (AMH) (median 13.0 versus 17.8 pmol/l). Survivors cured with minimal gonadotoxic treatment had significantly higher AMH and AFC compared with survivors cured with either potentially gonadotoxic treatment or treatment including alkylating chemotherapy and ovarian irradiation (20.0, 5.8 and <3 pmol/l, P<0.001; and 15, 9 and 2, P=0.03, respectively). Thirty-eight survivors had achieved at least one live birth. Complicated second-trimester abortions (n=4) were observed primarily in survivors cured with radiotherapy affecting pelvic organs. In conclusion, childhood cancer survivors have signs of diminished ovarian reserve. However, if the ovarian function is preserved in the early to mid-twenties, it is likely to persist until the mid-thirties, giving a good chance of childbearing.
先前，本研究小组发现，女性儿童癌症幸存者可能有生育能力早期终止的风险。本研究的目的是在最初研究 10 年后评估同一组幸存者的生殖功能。在最初的 100 名队列中，有 71 名接受了重新检查。36 名幸存者报告有规律的月经周期。当将她们与 210 名对照者进行比较时，她们的窦卵泡计数（AFC）差异显著（中位数 15 对 18，P=0.047），但抗苗勒氏管激素（AMH）差异不显著（中位数 13.0 对 17.8 pmol/l）。接受最低性腺毒性治疗的幸存者的 AMH 和 AFC 显著高于接受潜在性腺毒性治疗或包括烷化剂化疗和卵巢照射治疗的幸存者（20.0、5.8 和 <3 pmol/l，P<0.001；15、9 和 2，P=0.03）。38 名幸存者至少有一次活产。复杂的中期流产（n=4）主要发生在接受影响盆腔器官放射治疗的幸存者中。总之，儿童癌症幸存者有卵巢储备减少的迹象。然而，如果在 20 多岁早期到中期保留卵巢功能，那么很可能会持续到 30 多岁，从而有很好的生育机会。
