Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
Department of Nursing, Keio University Hospital, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
J Ovarian Res. 2023 Aug 10;16(1):159. doi: 10.1186/s13048-023-01250-x.
The indications for fertility preservation (FP) have expanded. A few patients who underwent gonadotoxic treatment did not have the opportunity to receive FP, leading to concerns that these patients may develop premature ovarian insufficiency. However, the usefulness of FP in women with reduced ovarian reserve has also been questioned. Progestin-primed ovarian stimulation can improve the controlled ovarian stimulation (COS) protocol, but there is limited data on the efficacy of FP with progestin-primed ovarian stimulation.
We conducted a prospective study of 43 women with cancer or autoimmune diseases before and after gonadotoxic treatment at the reproductive unit of Keio University Hospital, counselled between 1 January 2018 and 31 December 2021. After counselling, informed consent was obtained for FP from 43 patients, with those who underwent gonadotoxic treatment of the primary disease being prioritised. Gonadotropin-releasing hormone analogue or progestin was used to suppress luteinising hormone in COS before or after gonadotoxic treatment. The number of cryopreserved mature oocytes was the primary outcome.
Forty-three patients and 67 assisted reproductive technology cycles were included in the analysis. The median age at entry was 32 [inter quartile range (IQR), 29-37] years. All patients in the post-gonadotoxic treatment group had their oocytes frozen. Gonadotoxic treatment resulted in fewer oocytes [median 3 (IQR 1-4); pre-gonadotoxic treatment group: five patients, 13 cycles] vs. median 9 (IQR 5-14; pre-gonadotoxic treatment group: 38 patients, 54 cycles; P < 0.001). Although anti-Müllerian hormone levels were lower in the post-gonadotoxic treatment group (n = 5, 13 cycles, median 0.29 (IQR 0.15-1.04) pg/mL) than in the pre-gonadotoxic treatment group (n = 38, 54 cycles, median 1.89 (IQR 1.15-4.08) pg/mL) (P = 0.004), oocyte maturation rates were higher in the post-gonadotoxic treatment group [median 100 (IQR 77.5-100) %] than in the pre-gonadotoxic group [median 90.3 (IQR 75.0-100) %; P = 0.039]. Five patients in the pre-gonadotoxic treatment group had their cryopreserved embryos thawed, of which three had live births.
Oocytes obtained for FP from women with cancer or autoimmune disease for FP are of satisfactory quality, regardless of whether they are obtained post-gonadotoxic treatment or COS protocols.
生育力保存（FP）的适应证已经扩大。一些接受性腺毒性治疗的患者没有机会接受 FP，这引发了人们对这些患者可能会出现卵巢早衰的担忧。然而，孕激素预处理的卵巢刺激在卵巢储备功能降低的女性中是否有用也存在疑问。孕激素预处理可以改善控制性卵巢刺激（COS）方案，但孕激素预处理的 FP 疗效的数据有限。
我们在庆应义塾大学医院的生殖单位对 43 名患有癌症或自身免疫性疾病的患者进行了前瞻性研究，这些患者在性腺毒性治疗前和性腺毒性治疗后（2018 年 1 月 1 日至 2021 年 12 月 31 日）接受了咨询。咨询后，43 名患者获得了 FP 的知情同意，优先考虑原发性疾病接受性腺毒性治疗的患者。在性腺毒性治疗前或后，使用促性腺激素释放激素类似物或孕激素抑制 COS 中的黄体生成素。冷冻保存的成熟卵母细胞数量是主要结局。
43 名患者和 67 个辅助生殖技术周期被纳入分析。入组时的中位年龄为 32 [四分位距（IQR），29-37]岁。所有接受性腺毒性治疗后的患者都冷冻了她们的卵母细胞。性腺毒性治疗导致卵母细胞数量减少[中位数 3（IQR 1-4）；性腺毒性治疗前组：5 例，13 个周期]，而中位数 9（IQR 5-14；性腺毒性治疗前组：38 例，54 个周期；P<0.001）。尽管接受性腺毒性治疗后的患者抗苗勒管激素水平较低（n=5，13 个周期，中位数 0.29（IQR 0.15-1.04）pg/mL），但与接受性腺毒性治疗前组（n=38，54 个周期，中位数 1.89（IQR 1.15-4.08）pg/mL）相比（P=0.004），接受性腺毒性治疗后的患者卵母细胞成熟率更高[中位数 100%（IQR 77.5-100%）]，而接受性腺毒性治疗前组的卵母细胞成熟率中位数为 90.3%（IQR 75.0-100%）（P=0.039）。接受性腺毒性治疗前组的 5 名患者解冻了她们的冷冻胚胎，其中 3 名患者活产。
无论是否接受性腺毒性治疗或 COS 方案，从患有癌症或自身免疫性疾病的女性中获得用于 FP 的卵母细胞质量都令人满意。
