Société de Recherche pour l'Infertilité, Avenue Grandchamp, 143, B-1150 Brussels, Belgium.
Nat Rev Endocrinol. 2013 Dec;9(12):735-49. doi: 10.1038/nrendo.2013.205. Epub 2013 Oct 29.
In women, ∼10% of cancers occur in those <45 years old. Chemotherapy, radiotherapy and bone marrow transplantation can cure >90% of girls and young women with diseases that require such treatments. However, these treatments can result in premature ovarian failure, depending on the follicular reserve, the age of the patient and the type and dose of drugs used. This article discusses the different fertility preservation strategies: medical therapy before chemotherapy; ovarian transposition; embryo cryopreservation; oocyte vitrification; and ovarian tissue cryopreservation. The indications, results and risks of these options are discussed. Whether medical therapy should be used to protect the gonads during chemotherapy remains a source of debate. Fertility preservation needs to be completed before chemotherapy and/or irradiation is started and might take 2-3 weeks with established techniques such as embryo or oocyte cryopreservation. Further studies are needed in patients with cancer to confirm the excellent outcomes obtained in patients without cancer or in egg donation programmes. For prepubertal girls or cases where immediate therapy is required, cryopreservation of ovarian tissue is the only available option. Finally, possible future approaches are reviewed, including in vitro maturation of nonantral follicles, the artificial ovary, oogonial stem cells and drugs to prevent follicle loss.
在女性中，约有 10%的癌症发生在<45 岁的人群中。化疗、放疗和骨髓移植可以治愈需要此类治疗的>90%的女孩和年轻女性。然而，这些治疗可能会导致卵巢早衰，具体取决于卵泡储备、患者年龄以及所使用药物的类型和剂量。本文讨论了不同的生育力保存策略：化疗前的药物治疗；卵巢移位；胚胎冷冻保存；卵母细胞玻璃化冷冻；以及卵巢组织冷冻保存。讨论了这些选择的适应证、结果和风险。在化疗期间是否应该使用药物治疗来保护性腺仍然存在争议。生育力保存需要在开始化疗和/或放疗之前完成，并且可能需要 2-3 周的时间才能完成，如胚胎或卵母细胞冷冻保存等成熟技术。需要在癌症患者中进一步研究，以确认在无癌症患者或在卵子捐赠计划中获得的出色结果。对于青春期前的女孩或需要立即治疗的情况，卵巢组织的冷冻保存是唯一可行的选择。最后，还回顾了可能的未来方法，包括非腔卵泡的体外成熟、人工卵巢、卵原干细胞和预防卵泡丢失的药物。
