Reynolds Kasey A, Grindler Natalia M, Rhee Julie S, Cooper Amber R, Ratts Valerie S, Carson Kenneth R, Jungheim Emily S
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, United States of America.
Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America; Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America; Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri, United States of America.
PLoS One. 2015 May 26;10(5):e0127335. doi: 10.1371/journal.pone.0127335. eCollection 2015.
Fertility is important to women and men with cancer. While options for fertility preservation (FP) are available, knowledge regarding the medical application of FP is lacking. Therefore we examined FP practices for cancer patients among reproductive endocrinologists (REs). A 36 item survey was sent to board-certified REs. 98% of respondents reported counseling women with cancer about FP options. Oocyte and embryo cryopreservation were universally offered by these providers, but variability was noted in reported management of these cases-particularly for women with breast cancer. 86% of the respondents reported using letrozole during controlled ovarian stimulation (COS) in patients with estrogen receptor positive (ER+) breast cancer to minimize patient exposure to estrogen. 49% of respondents who reported using letrozole in COS for patients with ER+ breast cancer reported that they would also use letrozole in COS for women with ER negative breast cancer. Variability was also noted in the management of FP for men with cancer. 83% of participants reported counseling men about sperm banking with 22% recommending against banking for men previously exposed to chemotherapy. Overall, 79% of respondents reported knowledge of American Society for Clinical Oncology FP guidelines-knowledge that was associated with providers offering gonadal tissue cryopreservation (RR 1.82, 95% CI 1.14-2.90). These findings demonstrate that RE management of FP in cancer patients varies. Although some variability may be dictated by local resources, standardization of FP practices and communication with treating oncologists may help ensure consistent recommendations and outcomes for patients seeking FP.
生育能力对患有癌症的女性和男性都很重要。虽然有生育力保存（FP）的相关选择，但关于FP医学应用的知识却很匮乏。因此，我们调查了生殖内分泌学家（REs）对癌症患者的FP治疗情况。向获得委员会认证的REs发送了一份包含36个条目的调查问卷。98%的受访者表示会为患癌女性提供关于FP选择的咨询。这些医疗服务提供者普遍提供卵母细胞和胚胎冷冻保存服务，但在这些病例的报告管理方面存在差异——尤其是对于乳腺癌女性患者。86%的受访者报告称，在雌激素受体阳性（ER+）乳腺癌患者的控制性卵巢刺激（COS）过程中使用来曲唑，以尽量减少患者接触雌激素。在ER+乳腺癌患者的COS中使用来曲唑的受访者中，49%表示他们也会在ER阴性乳腺癌女性患者的COS中使用来曲唑。在癌症男性患者的FP管理方面也存在差异。83%的参与者表示会为男性提供精子库咨询，22%建议曾接受过化疗的男性不要进行精子库保存。总体而言，79%的受访者表示了解美国临床肿瘤学会的FP指南——这种了解与提供性腺组织冷冻保存服务的医疗服务提供者有关（相对风险1.82，95%置信区间1.14 - 2.90）。这些发现表明，REs对癌症患者FP的管理存在差异。尽管有些差异可能由当地资源决定，但FP治疗的标准化以及与肿瘤治疗医生的沟通可能有助于确保为寻求FP的患者提供一致的建议和结果。
