Dolmans Marie-Madeleine, Manavella Diego D
Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
J Obstet Gynaecol Res. 2019 Feb;45(2):266-279. doi: 10.1111/jog.13818. Epub 2018 Sep 23.
Most cancer treatments like chemotherapy, radiotherapy or a combination of both are highly toxic to the gonads, putting girls and young women at risk of premature ovarian insufficiency and subsequent infertility. Non-oncological conditions may also require therapies that put women's reproductive potential at risk. Fertility preservation counseling should therefore be offered to all patients requiring gonadotoxic treatments, and to those who wish to postpone motherhood for social/personal reasons. Among the most effective fertility preservation options available today, oocyte and embryo cryopreservation, and ovarian tissue cryopreservation have emerged as the front-runners.
This review focuses on the currently available and most widely accepted fertility preservation and restoration strategies, with a special focus on recent advances in ovarian tissue cryopreservation and transplantation.
To manage cancer patients satisfactorily and offer proper counsel on the most appropriate option available to them, different parameters need to be taken into account, including pubertal status, partner status and urgency of treatment for the underlying pathology. When fertility preservation is carried out for non-oncological indications or personal reasons, oocyte cryopreservation by vitrification is clearly the highest-yield clinical strategy. Ovarian tissue cryopreservation followed by transplantation is rapidly gaining ground as a fertility preservation and restoration strategy, and will hopefully soon have its 'experimental' label removed to allow practitioners to move on to open clinical application. Techniques to improve grafted ovarian tissue life span and quality as well as to avoid transmission of malignant cells have been developed, showing promise as a way to expand this procedure.
大多数癌症治疗方法，如化疗、放疗或两者结合，对性腺具有高度毒性，使女孩和年轻女性面临过早卵巢功能不全及随后不孕的风险。非肿瘤性疾病也可能需要一些对女性生殖潜能有风险的治疗方法。因此，应向所有需要进行性腺毒性治疗的患者，以及那些因社会/个人原因希望推迟生育的患者提供生育力保存咨询。在当今可用的最有效的生育力保存选择中，卵母细胞和胚胎冷冻保存以及卵巢组织冷冻保存已成为领先方法。
本综述聚焦于当前可用且被广泛接受的生育力保存和恢复策略，特别关注卵巢组织冷冻保存和移植的最新进展。
为了令人满意地管理癌症患者并就最适合他们的选择提供适当建议，需要考虑不同参数，包括青春期状态、伴侣状况以及基础疾病的治疗紧迫性。当为非肿瘤适应症或个人原因进行生育力保存时，玻璃化冷冻卵母细胞显然是临床收益最高的策略。卵巢组织冷冻保存后进行移植作为一种生育力保存和恢复策略正在迅速兴起，有望很快去掉其“实验性”标签，以便从业者能够转向开放临床应用。已经开发出提高移植卵巢组织寿命和质量以及避免恶性细胞传播的技术，显示出作为扩大该手术应用范围的一种方法的前景。
