Guenther Veronika, Alkatout Ibrahim, Junkers Wiebe, Bauerschlag Dirk, Maass Nicolai, von Otte Soeren
Department of Gynaecology and Obstetrics, UKSH Campus Kiel, Kiel, Germany.
University Fertility Centre, Medical Care Centre, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Geburtshilfe Frauenheilkd. 2017 Oct;77(10):1088-1094. doi: 10.1055/s-0043-119543. Epub 2017 Oct 26.
Many premenopausal patients who develop breast cancer have not yet completed their family planning, so measures of fertility protection to preserve their fertile potential would be beneficial. Polychemotherapy causes irreversible damage to the ovarian follicles - irrespective of whether in a neoadjuvant or adjuvant setting - and this can sometimes result in permanent infertility. Depending on which cytostatic agents are used and on the age-related ovarian reserve of the woman, gonadotoxic risk must be classified as low, moderate or high. Options of fertility preservation include: a) cryopreservation of fertilised or unfertilised oocytes. After ovarian hyperstimulation, mature oocytes are retrieved by transvaginal follicle aspiration, after which they are cryopreserved, either unfertilised or on completion of IVF or ICSI treatment. During b) cryopreservation of ovarian tissue, about 50% of the ovarian cortex of one ovary is resected with the aid of a laparoscopic procedure and cryopreserved. The application of c) GnRH agonists as a medicinal therapy option is an attempt at endocrine ovarian suppression in order to protect oocytes, granulosa cells and theca cells from the cytotoxic effect of chemotherapy.
许多患乳腺癌的绝经前患者尚未完成计划生育，因此采取生育保护措施以保留其生育潜力将是有益的。多药化疗会对卵巢卵泡造成不可逆的损害——无论在新辅助治疗还是辅助治疗中——这有时会导致永久性不孕。根据所使用的细胞毒性药物以及女性与年龄相关的卵巢储备情况，性腺毒性风险必须分为低、中、高。生育力保存的选择包括：a）冷冻保存受精卵或未受精卵母细胞。在卵巢过度刺激后，通过经阴道卵泡抽吸术获取成熟卵母细胞，然后将其冷冻保存，可在未受精时或体外受精或卵胞浆内单精子注射治疗完成后进行。b）冷冻保存卵巢组织时，借助腹腔镜手术切除一侧卵巢约50%的卵巢皮质并进行冷冻保存。c）应用促性腺激素释放激素（GnRH）激动剂作为一种药物治疗选择，是试图通过内分泌抑制卵巢，以保护卵母细胞、颗粒细胞和卵泡膜细胞免受化疗的细胞毒性作用。
