AYA Unit, Department of Hematology, Fertility Preservation, Hôpital Saint Louis, Paris, France.
Sorbonne University, Paris, France.
Acta Obstet Gynecol Scand. 2019 May;98(5):630-637. doi: 10.1111/aogs.13616. Epub 2019 Apr 14.
The preservation of fertility is an integral part of care of children requiring gonadotoxic treatments for cancer or non-malignant diseases. In France, the cryopreservation of ovarian tissue has been considered and has been offered as a clinical treatment since its inception. The aim of this study is to review 20 years of activity in fertility preservation by ovarian tissue cryopreservation (OTC) for children and the feasibility of oocyte isolation and cryopreservation from the ovarian tissue at a single center.
Retrospective study including patients aged 15 years or younger who underwent OTC, combined for some with oocyte cryopreservation of isolated oocytes, before a highly gonadotoxic treatment for malignant or non-malignant disease was initiated. We describe the evolution of activities in our program for fertility preservation and patient characteristics at the time of OTC and follow up.
From April 1998 to December 2018, 418 girls and adolescents younger than 15 years of age underwent OTC, representing 40.5% of all females who have had ovarian tissue cryopreserved at our center. In all, 313 patients had malignant diseases and 105 had benign conditions. Between November 2009 and July 2013, oocytes were isolated and also cryopreserved in 50 cases. The mean age of patients was 6.9 years (range 0.3-15). The most frequent diagnoses in this cohort included neuroblastoma, acute leukemia and hemoglobinopathies; neuroblastoma being the most common diagnosis in very young patients. During follow up, three patients requested the use of their cryopreserved ovarian tissue. All had undergone ovarian tissue transplantation, one for puberty induction and the two others for restoring fertility. So far, no pregnancies have been achieved. Eighty-four patients who had OTC died.
Ovarian tissue cryopreservation is the only available technique for preserving fertility of girls. To our knowledge this is the largest series of girls and adolescents younger than 15 years so far reported on procedures of OTC before highly gonadotoxic treatment in a single center.
对于因癌症或非恶性疾病而需要性腺毒性治疗的儿童，生育力的保存是治疗的重要组成部分。在法国，自卵巢组织冷冻保存技术出现以来，人们一直考虑并将其作为一种临床治疗方法。本研究旨在回顾 20 年来通过卵巢组织冷冻保存（OTC）为儿童进行生育力保存的活动，并评估在单一中心从卵巢组织中分离和冷冻卵母细胞的可行性。
回顾性研究纳入了在开始接受高度性腺毒性治疗前因恶性或非恶性疾病而接受 OTC 治疗的年龄在 15 岁或以下的患者，一些患者同时进行了分离卵母细胞的 OTC。我们描述了我们的生育力保存计划中的活动演变，以及 OTC 时和随访时患者的特征。
1998 年 4 月至 2018 年 12 月，418 名年龄在 15 岁以下的女孩和青少年接受了 OTC，占本中心所有接受卵巢组织冷冻保存的女性的 40.5%。所有患者中，313 例患有恶性疾病，105 例患有良性疾病。2009 年 11 月至 2013 年 7 月期间，50 例患者分离并冷冻了卵母细胞。患者的平均年龄为 6.9 岁（范围为 0.3-15 岁）。该队列中最常见的诊断包括神经母细胞瘤、急性白血病和血红蛋白病；神经母细胞瘤是最常见于非常年幼患者的诊断。在随访期间，有 3 名患者要求使用其冷冻保存的卵巢组织。所有患者均接受了卵巢组织移植，1 例用于诱导青春期，另外 2 例用于恢复生育力。到目前为止，尚未怀孕。接受 OTC 的 84 名患者死亡。
卵巢组织冷冻保存是保存女孩生育力的唯一可用技术。据我们所知，这是迄今为止在单一中心报道的关于高度性腺毒性治疗前 15 岁以下女孩和青少年 OTC 程序的最大系列。
