McCracken Kate, Nahata Leena
aSection of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital bDivision of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine cCenter for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital dDivision of Endocrinology, The Ohio State University/Nationwide Children's Hospital, Columbus, Ohio, USA.
Curr Opin Obstet Gynecol. 2017 Oct;29(5):283-288. doi: 10.1097/GCO.0000000000000395.
The purpose of this review is to outline current pediatric fertility preservation options, and discuss ethical and financial considerations impacting this rapidly expanding field.
With the improvement in treatment of pediatric malignancies and medical conditions that threaten fertility, survival rates are increasing. Therefore, minimizing long-term morbidities such as gonadal damage and infertility is of utmost importance. Impaired fertility not only has a significant negative impact on patient's quality of life; in women, gonadal damage puts patients at risk for premature menopause, and increased risk of cardiac, skeletal, and cognitive issues. Fortunately, fertility preservation options exist for both female and male prepubertal and pubertal patients, and discussion of such options with patients and their families prior to the initiation of therapy and/or before further deterioration of gonadal function is crucial. A multidisciplinary approach to fertility counseling, with attention to the patient's goals and cultural beliefs, is ideal.
Although several national organizations support integrating a fertility consultation into routine care, fertility preservation is still underutilized. Continued research is needed to understand barriers for patients/families and reduce the number of missed opportunities for fertility preservation.
本综述旨在概述当前儿科生育力保存的选择，并讨论影响这一迅速发展领域的伦理和财务考量。
随着儿科恶性肿瘤和威胁生育力的疾病治疗方法的改进，生存率不断提高。因此，将性腺损伤和不孕等长期发病率降至最低至关重要。生育力受损不仅会对患者的生活质量产生重大负面影响；对女性而言，性腺损伤会使患者面临过早绝经的风险，以及心脏、骨骼和认知问题风险增加。幸运的是，青春期前和青春期的男女患者都有生育力保存选择，在开始治疗和/或性腺功能进一步恶化之前，与患者及其家人讨论这些选择至关重要。采用多学科方法进行生育咨询，并关注患者的目标和文化信仰，是理想的做法。
尽管有几个国家组织支持将生育咨询纳入常规护理，但生育力保存的利用率仍然很低。需要持续开展研究，以了解患者/家庭面临的障碍，并减少生育力保存错失机会的数量。
