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治疗性流产后立即进行生育力保存会导致多个正常卵泡生长,但由于黄体过早形成,没有成熟的卵母细胞:病例报告及文献复习。

Fertility preservation immediately after therapeutic abortion results in multiple normal follicular growth with the absence of mature oocytes due to early luteinization: a case report and literature review.

机构信息

Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan.

Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan.

出版信息

Gynecol Endocrinol. 2021 Nov;37(11):1050-1053. doi: 10.1080/09513590.2021.1950135. Epub 2021 Jul 24.

DOI:10.1080/09513590.2021.1950135
PMID:34304673
Abstract

Cancer therapy has priority over fertility preservation. The time available for fertility preservation in patients with cancer is often very limited and depends on the condition of the underlying disease. This case report presents the results of two rounds of controlled ovarian stimulations (COSs) performed after an induced abortion. The patient had mixed phenotype acute leukemia diagnosed during early pregnancy and underwent a surgical abortion, followed by ovarian stimulation using urinary follicle-stimulating hormone (uFSH) and gonadotropin-releasing hormone (GnRH) agonists. Oocyte retrieval was subsequently performed for oocyte cryopreservation. Despite good hormonal and ultrasonic follicular growth, no oocytes were obtained. During a second COS performed at a low human chorionic gonadotropin (hCG) level (less than 100 IU/L), several mature oocytes were obtained, suggesting that higher hCG levels during COS induce the absence of mature oocytes during normal follicular growth. It is recommended to start COS post-abortion after confirming a low hCG level while considering the timing of cancer treatment.

摘要

癌症治疗优先于生育力保存。癌症患者进行生育力保存的可用时间往往非常有限,取决于潜在疾病的状况。本病例报告介绍了两次诱导性流产后进行的控制性卵巢刺激(COS)的结果。该患者在早期妊娠时被诊断出患有混合表型急性白血病,并接受了手术流产,随后使用尿促卵泡激素(uFSH)和促性腺激素释放激素(GnRH)激动剂进行卵巢刺激。随后进行卵母细胞采集以进行卵母细胞冷冻保存。尽管激素和超声卵泡生长良好,但未获得卵母细胞。在第二次人绒毛膜促性腺激素(hCG)水平较低(<100IU/L)的 COS 中,获得了几个成熟的卵母细胞,这表明在正常卵泡生长过程中,COS 期间较高的 hCG 水平会导致成熟卵母细胞的缺失。建议在确认 hCG 水平较低的情况下在流产后开始进行 COS,同时考虑癌症治疗的时机。

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Fertility preservation in pregnant cancer patients after first-trimester abortion: a new challenge with possible solutions.早孕期人工流产后妊娠合并恶性肿瘤患者的生育力保存:新的挑战与可能的解决方案。
J Assist Reprod Genet. 2023 Dec;40(12):2819-2825. doi: 10.1007/s10815-023-02950-5. Epub 2023 Oct 5.