Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Reprod Biomed Online. 2022 Oct;45(4):763-778. doi: 10.1016/j.rbmo.2022.05.020. Epub 2022 May 31.
Ovarian tissue cryopreservation and subsequent autotransplantation is a successful technique for fertility preservation in oncological patients. However, there are concerns regarding safety, as the graft may contain malignant cells that could lead to the reintroduction of cancer. To circumvent this problem several experimental strategies are being pursued. This systematic review was conducted to provide an overview of the strategies aiming to safely use cryopreserved human ovarian tissue to restore fertility after cancer. Thirty-one studies were included, covering five different experimental strategies: (i) in-vitro maturation of oocytes, (ii) constructing an artificial ovary as a scaffold for reseeding pre-antral follicles, (iii) purging strategies aimed at the eradication of contaminating malignant cells, (iv) maturation of oocytes by xenotransplantation, and (v) stem cell-based oogenesis. These strategies to circumvent the reintroduction of cancer cells through ovarian tissue autotransplantation are being developed, but so far have not reached the stage of clinical trials. Further research is required to establish their risks and effectiveness while the ethical aspects associated with these strategies also need to be discussed. Despite the fact that these experimental procedures are still under development, they might provide safe fertility restoration options for oncological patients in the future.
卵巢组织冷冻保存和随后的自体移植是一种成功的生育力保存技术,适用于肿瘤患者。然而,人们对安全性存在担忧,因为移植物中可能含有恶性细胞,这可能导致癌症的重新引入。为了规避这个问题,正在研究几种实验策略。本系统评价旨在提供一个概述,介绍旨在安全使用冷冻保存的人类卵巢组织来恢复癌症后生育力的策略。共纳入 31 项研究,涵盖了五种不同的实验策略:(i)卵母细胞体外成熟,(ii)构建人工卵巢作为再播种窦前卵泡的支架,(iii)清除策略旨在消除污染的恶性细胞,(iv)异种移植成熟卵母细胞,以及(v)基于干细胞的卵发生。这些通过卵巢组织自体移植来规避癌细胞再引入的策略正在开发中,但迄今为止尚未进入临床试验阶段。需要进一步的研究来确定其风险和有效性,同时也需要讨论与这些策略相关的伦理问题。尽管这些实验程序仍在开发中,但它们可能为未来的肿瘤患者提供安全的生育力恢复选择。