Guzy Laura, Demeestere Isabelle
Obstetrics and Gynecology Department, Saint-Pierre Hospital, Brussels, Belgium.
Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium -
Minerva Ginecol. 2017 Feb;69(1):57-67. doi: 10.23736/S0026-4784.16.03992-7. Epub 2016 Oct 27.
The survival rate of chemotherapy treatments of malignant cancer or non-malignant conditions are continuously improving. As a result, there is an increased number of patients who received a gonadotoxic treatment during childhood and who later face fertility issues. Depending on the extent of the damage to the ovaries, acute or late complications may occur. Acute ovarian failure is defined by permanent amenorrhea after a high-risk treatment. When the drugs used are less gonadotoxic, ovarian insufficiency might appear later. This literature review will review both the current solutions for management of high-risk patients and the care options for low and medium risk patients.
For each patient the risk of premature ovarian insufficiency should be evaluated individually before treatment. Guidelines clearly recommend to preserve fertility of high-risk group before treatment, but questions remain about the future counselling of patients with low or moderate risk.
Demand for fertility preservation methods has greatly increased. In this context, studies focusing on the best fertility preservation methods for patients, either before chemotherapy for the high-risk group or during the follow-up for the others, are essential. For the high-risk group, ovarian tissue cryopreservation is the only option for prepubertal girls. For postpubertal girls, oocytes vitrification could also be offered.
The risk of premature ovarian failure must be evaluated for each patient treated with gonadotoxic therapies. Fertility preservation must be offered in high-risk patients and appropriate follow-up should be proposed to anticipate later fertility issue in low and medium risk patients.
恶性癌症或非恶性疾病化疗治疗的生存率在不断提高。因此，童年时期接受性腺毒性治疗且后来面临生育问题的患者数量有所增加。根据卵巢受损程度，可能会出现急性或晚期并发症。急性卵巢功能衰竭定义为在接受高风险治疗后出现永久性闭经。当使用的药物性腺毒性较小时，卵巢功能不全可能会在后期出现。本文献综述将回顾高风险患者管理的当前解决方案以及低风险和中等风险患者的护理选择。
对于每位患者，在治疗前应单独评估卵巢早衰的风险。指南明确建议在治疗前保护高风险组患者的生育能力，但对于低风险或中等风险患者的未来咨询仍存在疑问。
对生育力保存方法的需求大幅增加。在此背景下，针对患者的最佳生育力保存方法的研究至关重要，无论是针对高风险组患者化疗前还是其他患者随访期间。对于高风险组，卵巢组织冷冻保存是青春期前女孩的唯一选择。对于青春期后女孩，也可以提供卵母细胞玻璃化冷冻。
对于接受性腺毒性治疗的每位患者，都必须评估卵巢早衰的风险。必须为高风险患者提供生育力保存，并应为低风险和中等风险患者提供适当的随访，以预测后期的生育问题。
