Senior Clinical Fellow in Reproductive Medicine and Assisted Conception, Fertility Preservation Service, ACU, Guy's Hospital, London, UK.
Consultant Gynaecologist and Subspecialist in Reproductive Medicine and Surgery, ACU, Guy's Hospital, London, UK.
Eur J Obstet Gynecol Reprod Biol. 2023 Nov;290:93-100. doi: 10.1016/j.ejogrb.2023.09.020. Epub 2023 Sep 24.
To the best of our knowledge, the available evidence on the effect and efficacy of controlled ovarian stimulation (COS) in this group of patients remains poorly reported. Concerns related to the impact of stimulation to cancer progression and recurrence, as well as the risk of disease dissemination during egg collection, might explain the aforementioned trend.
Overall, our FP Service received 192 gynaecological referrals, between 2005 and 2021, regarding gynaecologic conditions mainly cancer related. A total of 68 (35.4%) patients underwent COS. These patients were diagnosed with the following gynaecologic pathologies: 33 cases (48,5%) of cervical cancer were noted (stage 1b1-2b), 25 ovarian pathology (36.7%), 9 cases (13.2%) of endometrial cancer, and a single case of vaginal cancer (1.5%).
The mean age of patients attending the fertility preservation service was 31.5 (std 5.8). The patients presenting to their initial appointment with a mean BMI 24.5 (IQR 6.9) and a median AFC of 12 (IQR 13). The mean duration of COS was 11 days (IQR 3), and the median dose of gonadotrophins was calculated at 300 IU (IQR 75 IU). In 95.4% of the cases, GnRH agonist was used as a trigger for final maturation. The median number of follicles measuring more than 14 mm at the time of trigger was 11 (IQR 8), whereas the median number of oocytes collected was 11 (IQR 9). The complication rate was reported at less than 2%. So far, one in four women of this FP group (17/68, 25% of the overall group) returned to our service to claim their cryopreserved eggs/embryos and successful livebirths were reported in 58.8% of this sample (10/17 cases). The mean time to return to use their oocytes/embryos was 36 months (min value 16 months - max value 85 months). There was no significant difference in mortality rate between patients who received FP vs those who did not (hazard ratio of mortality was estimated at 0.91 (p-value 0.88)).
Based on our findings, ovarian stimulation for patients presenting with gynaecologic malignancy is a safe and efficient method of fertility preservation. Undoubtedly, the sample size is limited, however our results are reassuring and highlight the efficacy of COS for the purpose of FP based on data coming from the largest Assisted Conception Unit of the South-East of the UK.
据我们所知，关于这组患者控制性卵巢刺激（COS）的效果和疗效的现有证据仍报道不足。对刺激对癌症进展和复发的影响以及取卵过程中疾病传播的风险的担忧可能解释了上述趋势。
总体而言，我们的 FP 服务在 2005 年至 2021 年间共收到 192 例妇科转诊，主要涉及妇科癌症相关问题。共有 68 名（35.4%）患者接受了 COS。这些患者被诊断为以下妇科疾病：33 例（48.5%）宫颈癌（1b1-2b 期），25 例卵巢病变（36.7%），9 例子宫内膜癌（13.2%）和 1 例阴道癌（1.5%）。
接受生育力保存服务的患者的平均年龄为 31.5（标准差 5.8）。患者在首次就诊时的平均 BMI 为 24.5（IQR 6.9），AFC 中位数为 12（IQR 13）。COS 的平均持续时间为 11 天（IQR 3），促性腺激素的中位数剂量为 300IU（IQR 75IU）。在 95.4%的情况下，使用 GnRH 激动剂作为最终成熟的触发剂。在触发时测量超过 14mm 的卵泡中位数为 11（IQR 8），而采集的卵母细胞中位数为 11（IQR 9）。报告的并发症发生率低于 2%。到目前为止，该 FP 组中有四分之一的女性（17/68，占总组的 25%）回到我们的服务处要求使用冷冻保存的卵子/胚胎，并且该样本中有 58.8%（10/17 例）报告了活产。返回使用卵子/胚胎的平均时间为 36 个月（最小值 16 个月-最大值 85 个月）。接受 FP 治疗的患者与未接受 FP 治疗的患者之间的死亡率无显著差异（死亡率的风险比估计为 0.91（p 值 0.88））。
根据我们的发现，对患有妇科恶性肿瘤的患者进行卵巢刺激是一种安全有效的生育力保存方法。无疑，样本量有限，但我们的结果令人放心，并根据来自英国东南部最大辅助受孕单位的数据强调了 COS 用于 FP 的疗效。
