Devenutto L, Quintana R, Quintana T
Reproductive Medicine Service, "Procrearte", Institution Affiliated with the University of Buenos Aires (UBA), Buenos Aires, Argentina.
Hum Reprod Open. 2020 Nov 16;2020(4):hoaa046. doi: 10.1093/hropen/hoaa046. eCollection 2020.
Primary ovarian insufficiency (POI) and diminished ovarian reserve are two conditions that affect women's fertility. Oocyte donation remains an option for these patients; however, the development of certain novel technologies, such as activation of ovarian cortex (IVA), enables the possibility of activating the pool of resting primordial follicles, increasing the chance of pregnancy.
Here, we review the main pathways (PI3K and Hippo signaling) that govern the activation of primordial follicles and its application through the development of culture systems that support ovarian cortex for autologous transplantation. We also review the available data from case reports regarding outcomes of pregnancy and live birth rates with IVA.
A PubMed search was conducted using the PubMed-NCBI database to identify literature pertinent to the pathways involved in the activation of primordial follicles and the outcomes of IVA techniques from 2013 to the present.
Women with POI have around a 5% chance of spontaneous pregnancy. Recently, novel techniques involving the activation of primordial follicles through molecular pathways have been developed, thus increasing the odds of these patients. More recently, the introduction of a drug-free IVA technique has shown to increase the number of antral follicles with successful oocyte maturation after gonadotropin treatment, reaching pregnancy rates over 30%, either through spontaneous conception or by the implementation of assisted reproductive technology.
The evidence of this review is based on a few small series, so data should be interpreted with caution, and only randomized controlled trials could estimate the real magnitude and success of the procedure.
IVA technique remains an experimental strategy, with limited available data and the requirement of invasive procedures. Moreover, possible carcinogenic effects not yet determined after transplantation require special caution.
In view of the results achieved, IVA could provide a promising option for the preservation of fertility in some cancer patients and prepuberal girls where the only alternative is tissue cryopreservation.
STUDY FUNDING/COMPETING INTERESTS: The authors received no specific funding for this work and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
原发性卵巢功能不全（POI）和卵巢储备功能减退是影响女性生育能力的两种情况。卵母细胞捐赠仍是这些患者的一种选择；然而，某些新技术的发展，如卵巢皮质激活（IVA），使得激活静止的原始卵泡库成为可能，增加了怀孕几率。
在此，我们回顾了调控原始卵泡激活的主要信号通路（PI3K和Hippo信号通路），以及通过开发支持卵巢皮质自体移植的培养系统所实现的应用。我们还回顾了关于IVA的妊娠结局和活产率的病例报告中的现有数据。
使用PubMed-NCBI数据库进行PubMed检索，以识别2013年至今与原始卵泡激活相关的信号通路及IVA技术结局的相关文献。
POI女性自然怀孕的几率约为5%。最近，已开发出通过分子信号通路激活原始卵泡的新技术，从而增加了这些患者怀孕的几率。最近，一种无药物的IVA技术的引入显示，在促性腺激素治疗后，可增加窦卵泡数量并成功实现卵母细胞成熟，通过自然受孕或实施辅助生殖技术，妊娠率超过30%。
本综述的证据基于少数小样本系列研究，因此数据解读应谨慎，只有随机对照试验才能评估该手术的实际效果和成功率。
IVA技术仍是一种实验性策略，可用数据有限且需要侵入性操作。此外，移植后尚未确定的潜在致癌作用需要特别谨慎。
鉴于已取得的结果，IVA可为一些癌症患者和青春期前女孩的生育力保存提供一个有前景的选择，在这些情况下，唯一的替代方法是组织冷冻保存。
研究资金/利益冲突：作者未获得本研究的特定资金，且声明在本研究、作者身份和/或本文发表方面不存在潜在利益冲突。
