Wnuk Katarzyna, Świtalski Jakub, Miazga Wojciech, Tatara Tomasz, Religioni Urszula, Olszewski Paweł, Augustynowicz Anna
Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032 Warsaw, Poland.
School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826 Warsaw, Poland.
Cancers (Basel). 2023 Nov 9;15(22):5348. doi: 10.3390/cancers15225348.
Many cancer treatment methods can affect fertility by damaging the reproductive organs and glands that control fertility. Changes can be temporary or permanent. In order to preserve the fertility of cancer patients and protect the genital organs against gonadotoxicity, methods of fertility preservation are increasingly used. Considering that some patients ultimately decide not to use cryopreserved reproductive material, this review analysed the percentage of post-cancer patients using cryopreserved reproductive material, collected before treatment as part of fertility preservation.
A systematic search of studies was carried out in accordance with the Cochrane Collaboration guidelines, based on a previously prepared research protocol. The search was conducted in Medline (via PubMed), Embase (via OVID), and the Cochrane Library. In addition, a manual search was performed for recommendations/clinical practice guidelines regarding fertility preservation in cancer patients.
Twenty-six studies met the inclusion criteria. The studies included in the review discussed the results of cryopreservation of oocytes, embryos, ovarian tissue, and semen. In 10 studies, the usage rate of cryopreserved semen ranged from 2.6% to 21.5%. In the case of cryopreserved female reproductive material, the return/usage rate ranged from 3.1% to 8.7% for oocytes, approx. 9% to 22.4% for embryos, and 6.9% to 30.3% for ovarian tissue. In studies analysing patients' decisions about unused reproductive material, continuation of material storage was most often indicated. Recovering fertility or death of the patient were the main reasons for rejecting cryopreserved semen in the case of men.
Fertility preservation before gonadotoxic treatment is widely recommended and increasingly used in cancer patients. The usage rate is an important indicator for monitoring the efficacy of these methods. In all of the methods described in the literature, this indicator did not exceed 31%. It is necessary to create legal and organizational solutions regulating material collection and storage and to create clear paths for its usage in the future, including by other recipients.
许多癌症治疗方法会通过损害控制生育能力的生殖器官和腺体来影响生育能力。这些变化可能是暂时的或永久的。为了保留癌症患者的生育能力并保护生殖器官免受性腺毒性影响，生育力保存方法的使用越来越广泛。考虑到一些患者最终决定不使用冷冻保存的生殖材料，本综述分析了癌症患者使用作为生育力保存一部分在治疗前收集的冷冻保存生殖材料的比例。
根据Cochrane协作网指南，基于先前制定的研究方案对研究进行系统检索。检索在Medline（通过PubMed）、Embase（通过OVID）和Cochrane图书馆进行。此外，还对手动检索了有关癌症患者生育力保存的建议/临床实践指南。
26项研究符合纳入标准。综述中纳入的研究讨论了卵母细胞、胚胎、卵巢组织和精液冷冻保存的结果。在10项研究中，冷冻保存精液的使用率在2.6%至21.5%之间。对于冷冻保存的女性生殖材料，卵母细胞的归还/使用率在3.1%至8.7%之间，胚胎约为9%至22.4%，卵巢组织为6.9%至30.3%。在分析患者对未使用生殖材料的决定的研究中，最常表明继续保存材料。恢复生育能力或患者死亡是男性拒绝冷冻保存精液的主要原因。
在性腺毒性治疗前进行生育力保存被广泛推荐，且在癌症患者中使用越来越多。使用率是监测这些方法疗效的重要指标。在文献中描述的所有方法中，该指标均未超过31%。有必要制定规范材料收集和储存的法律和组织解决方案，并为其未来的使用，包括其他接受者的使用，创造明确的途径。
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