IVIRMA Valencia, Valencia, Spain.
IVIRMA Madrid and Universidad Rey Juan Carlos, Madrid, Spain.
Fertil Steril. 2021 May;115(5):1091-1101. doi: 10.1016/j.fertnstert.2021.02.006.
Growing evidence of successful outcomes achieved with the oocyte vitrification technique has greatly contributed to its application in the field of fertility preservation (FP). The population that can benefit from FP includes women at a risk of losing their ovarian function because of either iatrogenic causes or natural depletion of their ovarian reserve. Therefore, oncological patients and healthy women who wish to delay motherhood for various reasons-elective FP-are currently being offered this option. Satisfactory oocyte survival rates and clinical outcomes, including cumulative live birth rates, have been reported in recent years. These studies show that age at oocyte retrieval strongly affects reproductive prognosis after FP. Therefore, elective FP patients should be encouraged to decide before they reach the age of 35 years to significantly increase their chances of success. The effect of age has also been observed in patients with cancer and women diagnosed with endometriosis. The reproductive outcome after FP is worse in patients with cancer, but a direct association between the disease and reproductive outcome is yet to be proven. Young patients (≤35 years) with endometriosis who have undergone cystectomy before oocyte retrieval for FP have worse outcomes than nonoperated women in age-matched groups. In addition, the number of oocytes used per patient is closely related to success in all populations, with considerable improvement in the result with the addition of a few oocytes, especially in healthy young patients.
越来越多的证据表明卵母细胞玻璃化技术的成功应用极大地促进了其在生育力保存(FP)领域的应用。可以从 FP 中受益的人群包括因医源性原因或卵巢储备自然耗竭而有丧失卵巢功能风险的女性。因此,目前正在为肿瘤患者和出于各种原因希望推迟生育的健康女性(选择性 FP)提供这一选择。近年来,已有研究报道了令人满意的卵母细胞存活率和临床结局,包括累积活产率。这些研究表明,卵母细胞采集时的年龄强烈影响 FP 后的生殖预后。因此,应鼓励选择性 FP 患者在 35 岁之前做出决定,以显著提高成功的机会。年龄的影响也在癌症患者和诊断为子宫内膜异位症的女性中观察到。FP 后癌症患者的生殖结局较差,但疾病与生殖结局之间的直接关联尚未得到证实。在进行 FP 卵母细胞采集前接受过囊肿切除术的年轻(≤35 岁)子宫内膜异位症患者的结局比年龄匹配组中未接受手术的女性差。此外,每个患者使用的卵母细胞数量与所有人群的成功密切相关,随着添加几个卵母细胞,结果有了相当大的改善,尤其是在健康的年轻患者中。