Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago™, Chicago, Illinois; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago™, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Urol. 2017 Jul;198(1):186-194. doi: 10.1016/j.juro.2016.09.159. Epub 2017 Feb 9.
This review provides an overview of pediatric fertility preservation. Topics covered include the patient populations who could benefit, the current state of fertility preservation options and research, and considerations related to ethics and program development.
A broad Embase® and PubMed® search was performed to identify publications discussing investigational, clinical, ethical and health care delivery issues related to pediatric fertility preservation. Relevant publications were reviewed and summarized.
Populations who could benefit from fertility preservation in childhood/adolescence include oncology patients, patients with nononcologic conditions requiring gonadotoxic chemotherapy, patients with differences/disorders of sex development and transgender individuals. Peripubertal and postpubertal fertility preservation options are well established and include cryopreservation of oocytes, embryos or sperm. Prepubertal fertility preservation is experimental. Multiple lines of active research aim to develop technologies that will enable immature eggs and sperm to be matured and used to produce a biological child in the future. Ethical challenges include the need for parental proxy decision making and the fact that fertility preservation procedures can be considered not medically necessary. Successful multidisciplinary fertility preservation care teams emphasize partnerships with adult colleagues, prioritize timely consultations and use standardized referral processes. Some aspects of fertility preservation are not covered by insurance and out-of-pocket costs can be prohibitive.
Pediatric fertility preservation is an emerging, evolving field. Fertility preservation options for prepubertal patients with fertility altering conditions such as cancer and differences/disorders of sex development are currently limited. However, multiple lines of active research hold promise for the future. Key considerations include establishing a multidisciplinary team to provide pediatric fertility preservation services, an appreciation for relevant ethical issues and cost.
本文综述了儿科生育力保存。涵盖的主题包括可能受益的患者人群、当前生育力保存选择和研究的现状，以及与伦理和项目开发相关的考虑因素。
进行了广泛的 Embase® 和 PubMed® 检索，以确定讨论儿科生育力保存相关的研究、临床、伦理和医疗保健提供问题的出版物。回顾并总结了相关出版物。
儿童/青少年时期可能受益于生育力保存的人群包括肿瘤患者、需要性腺毒性化疗的非肿瘤疾病患者、差异/性别发育障碍患者和跨性别者。青春期前和青春期后的生育力保存选择已经成熟，包括卵母细胞、胚胎或精子的冷冻保存。青春期前的生育力保存尚处于实验阶段。多项正在进行的研究旨在开发使未成熟卵子和精子成熟并将来用于生育生物学后代的技术。伦理挑战包括需要父母代理决策以及生育力保存程序可能被认为不是医学必需的事实。成功的多学科生育力保存护理团队强调与成人同事的合作关系，优先及时咨询并使用标准化转诊流程。生育力保存的某些方面不在保险范围内，自费费用可能过高。
儿科生育力保存是一个新兴的、不断发展的领域。目前，癌症和性别差异/发育障碍等改变生育能力的疾病青春期前患者的生育力保存选择有限。然而，多项正在进行的研究为未来带来了希望。关键考虑因素包括建立一个提供儿科生育力保存服务的多学科团队、对相关伦理问题和成本的认识。
