Muteshi Charles, Child Tim, Ohuma Eric, Fatum Muhammad
Oxford Fertility, Institute of Reproductive Sciences, Oxford OX4 2HW, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; Endometriosis CaRe Centre, Oxford OX3 9DU, UK.
Oxford Fertility, Institute of Reproductive Sciences, Oxford OX4 2HW, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK.
Eur J Obstet Gynecol Reprod Biol. 2018 Nov;230:10-14. doi: 10.1016/j.ejogrb.2018.09.007. Epub 2018 Sep 11.
To determine response to controlled ovarian stimulation in a random start cycle and utilisation of cryopreserved oocytes and embryos in cancer patients.
A retrospective cohort study was carried out in an assisted reproductive treatment centre. Participants included 137 cancer patients who underwent controlled ovarian stimulation for fertility preservation between 1 Feb 2003 and 30 June 2016. The primary outcome variable was number of oocytes retrieved. Multivariable logistic regression analysis was performed, and differences compared using Chi squared test and student t-test as appropriate. P < 0.05 was considered statistically significant.
Using the antagonist protocol, there was no difference in number of oocytes retrieved between the early follicular phase or at random start stimulation; 11.9 (95% CI 10.3-13.5) and 12.9 (95% CI 9.6-16.2), P = 0.602, respectively. Similarly, the number of embryos frozen was comparable between those starting stimulation in early follicular and random phase, 6.7 (95% CI 5.7-7.7) and 5.1 (95% CI 3.6-6.5), P= 0.1508 respectively. Among patients undergoing fertility preservation, those who returned to attempt a pregnancy had an ongoing pregnancy rate of 24.3%. Overall, 65% of oocytes and embryos were still in storage, however, 16 (11.7%) had elected to have their oocytes or embryos disposed of.
CONCLUSION(S): For women faced with potential gonadotoxic treatment and requiring urgent fertility preservation, ovarian stimulation with the antagonist protocol can be started at random without compromising ovarian response. Pregnancy rates following utilisation of frozen-thawed oocytes and embryos are promising, however, more research is needed to understand reasons underlying disposition of oocytes and embryos especially when survival following cancer treatment has improved significantly.
确定癌症患者在随机起始周期中对控制性卵巢刺激的反应以及冷冻卵母细胞和胚胎的利用情况。
在一家辅助生殖治疗中心开展了一项回顾性队列研究。参与者包括137例在2003年2月1日至2016年6月30日期间接受控制性卵巢刺激以保存生育能力的癌症患者。主要结局变量是获取的卵母细胞数量。进行了多变量逻辑回归分析，并根据情况使用卡方检验和学生t检验比较差异。P < 0.05被认为具有统计学意义。
采用拮抗剂方案时，卵泡早期或随机起始刺激时获取的卵母细胞数量无差异，分别为11.9（95%可信区间10.3 - 13.5）和12.9（95%可信区间9.6 - 16.2），P = 0.602。同样，在卵泡早期和随机期开始刺激的患者中，冷冻胚胎数量相当，分别为6.7（95%可信区间5.7 - 7.7）和5.1（95%可信区间3.6 - 6.5），P = 0.1508。在接受生育力保存的患者中，那些返回尝试怀孕的患者持续妊娠率为24.3%。总体而言，65%的卵母细胞和胚胎仍在储存中，然而，16例（11.7%）选择处置其卵母细胞或胚胎。
对于面临潜在性腺毒性治疗且需要紧急保存生育力的女性，采用拮抗剂方案进行卵巢刺激可随机开始，而不会影响卵巢反应。利用冻融卵母细胞和胚胎后的妊娠率前景良好，然而，需要更多研究来了解卵母细胞和胚胎处置的潜在原因，尤其是在癌症治疗后的生存率显著提高时。
