Caserta D, Ralli E, Matteucci E, Marci R, Moscarini M
Department of Obstetrics Gynecological and Urological Sciences Sant' Andrea Hospital La Sapienza University of Rome, Rome, Italy -
Panminerva Med. 2014 Mar;56(1):85-95.
Fertility preservation has become an issue of great importance in female cancer patients due to increasing survival rates and delayed childbearing. It is an emerging challenge for physicians, cause of several related issues (multidisciplinary approach, doctor-patient communication, ethical, religious and legal problems) and many unresolved questions. This review aims to update the latest literature data, summarizing the effects of cancer treatments on female fertility and the various options currently available to offer cancer patients the opportunity of future pregnancies. Many strategies exist for fertility preservation in young women and they should be assessed according to the patient's age, type of cancer, partner status and time available. Some techniques are well established, others are still experimental. The established methods include embryo cryopreservation, transposition of ovaries prior to radiation therapy, radiation shielding of gonads and conservative surgical approaches. The experimental methods include oocyte cryopreservation, in vitro maturation of oocytes, ovarian tissue cryopreservation and transplantation, and ovarian suppression. Improvement of these techniques as well as better characterization of their success rates and risks, await further investigation. Oocytes donation and gestational surrogacy represent the last options. Thus, the care of these patients is challenging, complex and requires a multidisciplinary approach. A close collaboration between Oncologists, Specialists in Reproductive Medicine, Gynecologic Oncologists and Endocrinologists is crucial for always offering the best possible option.
由于生存率的提高和生育延迟，生育力保存已成为女性癌症患者的一个极为重要的问题。这对医生来说是一个新出现的挑战，涉及几个相关问题（多学科方法、医患沟通、伦理、宗教和法律问题）以及许多未解决的疑问。本综述旨在更新最新的文献数据，总结癌症治疗对女性生育力的影响以及目前可供癌症患者未来怀孕的各种选择。年轻女性有多种生育力保存策略，应根据患者的年龄、癌症类型、伴侣状况和可用时间进行评估。一些技术已成熟，另一些仍处于实验阶段。已确立的方法包括胚胎冷冻保存、放疗前卵巢移位、性腺放射防护和保守手术方法。实验方法包括卵母细胞冷冻保存、卵母细胞体外成熟、卵巢组织冷冻保存和移植以及卵巢抑制。这些技术的改进以及对其成功率和风险的更好描述，有待进一步研究。卵母细胞捐赠和妊娠代孕是最后的选择。因此，对这些患者的护理具有挑战性、复杂性，需要多学科方法。肿瘤学家、生殖医学专家、妇科肿瘤学家和内分泌学家之间的密切合作对于始终提供最佳选择至关重要。
