Sonigo Charlotte, Grynberg Michaël, Bringer Sophie, Sermondade Nathalie
Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 92140 Clamart, France; INSERM U1185, Université Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France.
Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 92140 Clamart, France; INSERM U1133, Université Paris-Diderot, 75013 Paris, France; Université Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France.
Bull Cancer. 2019 Dec;106(12S1):S43-S52. doi: 10.1016/S0007-4551(20)30047-3.
Over the past decades, progresses in oncology have improved the recovery rates after numerous malignant diseases, including breast cancer, that strike young adults in childbearing age. Quality of life of young cancer survivors has become a major issue. However, anticancer therapies can have a detrimental impact on fertility. It is now well-established that all patients should receive information about the fertility risks associated with their cancer treatment and the fertility preservation options available. These techniques aim to limit the negative impact of chemotherapy on the ovaries or to preserve gametes before treatment. Currently, oocyte or embryo freezing after controlled ovarian hyperstimulation represents the most effective method for preserving female fertility. Over the past years innovative protocols of ovarian stimulation have been developed to enable breast cancer patients to undergo oocyte or embryo cryopreservation irrespective of the phase of the cycle or without exogenous follicle-stimulating hormone related increase in serum estradiol levels. When controlled ovarian hyperstimualtion cannot be implemented, other techniques such as cryopreservation of ovarian cortex, in vitro maturation or the use of GnRH agonists may be proposed. However, it is important to inform patients that all these fertility preservation techniques do not represent a guarantee of pregnancy.
在过去几十年里，肿瘤学的进展提高了包括乳腺癌在内的多种侵袭育龄期年轻成年人的恶性疾病后的康复率。年轻癌症幸存者的生活质量已成为一个主要问题。然而，抗癌治疗可能会对生育能力产生不利影响。现在已经明确，所有患者都应该了解与其癌症治疗相关的生育风险以及可用的生育力保存选项。这些技术旨在限制化疗对卵巢的负面影响或在治疗前保存配子。目前，控制性卵巢过度刺激后进行卵母细胞或胚胎冷冻是保存女性生育力的最有效方法。在过去几年中，已经开发出创新的卵巢刺激方案，使乳腺癌患者无论处于月经周期的哪个阶段，或在血清雌二醇水平不因外源性促卵泡激素增加的情况下，都能进行卵母细胞或胚胎冷冻保存。当无法实施控制性卵巢过度刺激时，可能会建议采用其他技术，如卵巢皮质冷冻保存、体外成熟或使用促性腺激素释放激素激动剂。然而，重要的是要告知患者，所有这些生育力保存技术都不能保证怀孕。
