Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Obstet-Gynecol Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Assist Reprod Genet. 2019 Feb;36(2):341-348. doi: 10.1007/s10815-018-1345-8. Epub 2018 Oct 25.
Chemotherapy during childhood damages ovarian reserve and can affect future fertility. However, recent large epidemiological studies showed that the detrimental impact on fertility is less severe if women seek for pregnancy at a younger age. To explain this observation, we hypothesize that the detrimental effects of previous chemotherapy on the ovarian reserve may be attenuated in young adults for two main reasons. Firstly, recent evidence showed that the amount of ovarian reserve is not a critical factor for effective natural conceptions. Provided that the residual ovarian reserve allows regular ovulatory cycles, the chances of pregnancy are similar in women with intact or reduced ovarian reserve. Secondly, ovarian reserve depletion appears to be a phenomenon that is inversely related to the residual ovarian reserve rather than to age. From a mathematical perspective, this kind of regulation intrinsically attenuates the effects of an early loss of a significant amount of primordial follicles. In conclusion, the detrimental effects of chemotherapy on natural fertility may be less severe if women with a history of chemotherapy during childhood seek for pregnancy early. This information should be part of the counseling.
儿童时期的化疗会损害卵巢储备功能，并可能影响未来的生育能力。然而，最近的大型流行病学研究表明，如果女性在更年轻的时候寻求怀孕，对生育能力的不利影响就不那么严重了。为了解释这一观察结果，我们假设，以前的化疗对卵巢储备的不利影响在年轻人中可能会减轻，主要有两个原因。首先，最近的证据表明，卵巢储备的数量并不是自然受孕的关键因素。只要残留的卵巢储备允许正常的排卵周期，那么卵巢储备完整或减少的女性怀孕的机会是相似的。其次，卵巢储备耗竭似乎是一个与年龄相反的现象。从数学的角度来看，这种调节本质上减轻了早期大量原始卵泡丢失的影响。总之，如果在儿童时期接受过化疗的女性早期寻求怀孕，那么化疗对自然生育能力的不利影响可能就不那么严重了。这些信息应该是咨询的一部分。
