Department of Women's and Children's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
Department of Molecular Medicine-Biological Chemistry, University of Padova, 35131, Padua, Italy.
J Assist Reprod Genet. 2023 Dec;40(12):2819-2825. doi: 10.1007/s10815-023-02950-5. Epub 2023 Oct 5.
Fertility preservation in pregnant women recently diagnosed with cancer can be a challenge. Raised levels of human chorionic gonadotropin (Beta-hCG) and progesterone in this population of patients may pose a problem for the prompt initiation of controlled ovarian stimulation (COS) due to a potential negative feedback of these hormones on folliculogenesis; however, it is not feasible to wait for negativization of serum beta-hCG levels before starting controlled ovarian stimulation. In literature, very few cases have been reported regarding the preservation of fertility in pregnant women recently diagnosed with cancer. We performed an extended revision of the literature to evaluate the current knowledge of the management of fertility preservation in women with cancer and we examined two cases closely. The first case study involved a cancer patient who underwent surgical abortion at 6.5 weeks of gestation followed by administration of mifepristone to detach any minimal residual trophoblast and consequently to decrease serum beta-hCG and progesterone levels before starting COS. In the second case study, the cancer patient underwent surgical abortion at 7.1 weeks of gestation and simultaneous unilateral oophorectomy for ovarian tissue cryopreservation due to a limited time for COS. By analyzing the results of these studies, it could be hypothesized that mifepristone administration may favor the decrease of serum beta-hCG and progesterone levels in order to permit rapid initiation of COS. In cases where COS is not feasible, ovarian tissue cryopreservation should be considered as an alternative fertility preservation technique.
最近被诊断出患有癌症的孕妇的生育力保存可能是一个挑战。由于这些激素对卵泡发生的潜在负反馈作用，该患者人群中升高的人绒毛膜促性腺激素（β-hCG）和孕激素水平可能会导致即刻开始控制性卵巢刺激（COS）出现问题；然而，等待血清β-hCG 水平转阴后再开始控制性卵巢刺激是不可行的。在文献中，仅有少数关于最近被诊断出患有癌症的孕妇生育力保存的病例报道。我们对文献进行了扩展复习，以评估目前关于癌症患者生育力保存管理的知识，并仔细检查了两个案例。第一个病例研究涉及一名癌症患者，她在怀孕 6.5 周时接受了手术流产，然后服用米非司酮以分离任何微小的残留滋养层，并随后降低血清β-hCG 和孕激素水平，然后开始进行 COS。在第二个病例研究中，由于 COS 的时间有限，癌症患者在怀孕 7.1 周时接受了手术流产和单侧卵巢切除术以进行卵巢组织冷冻保存。通过分析这些研究的结果，可以假设米非司酮的使用可能有利于降低血清β-hCG 和孕激素水平，以便快速开始 COS。在不能进行 COS 的情况下，应考虑卵巢组织冷冻保存作为另一种生育力保存技术。
