Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
In Vivo. 2024 Jan-Feb;38(1):48-57. doi: 10.21873/invivo.13409.
Fertility preservation (FP) in pediatric and adolescent oncology patients presents a complex interplay between cancer treatment imperatives and reproductive aspirations, demanding a multi-disciplinary approach. Essential guidelines emphasize the importance of early referrals to FP specialists, ensuring timely counseling on oocyte and ovarian tissue cryopreservation options. Proper patient selection and risk assessment, considering intrinsic and extrinsic factors, is crucial for judicious resource utilization and optimal outcomes. Gonadotoxic effects of cancer treatments pose significant threats to reproductive capabilities. Oocyte cryopreservation (OC) is preferred in post-pubertal adolescents without partners. Cultural and religious concerns, especially regarding hymenal integrity, influence FP decisions, necessitating culturally sensitive consent processes. Ovarian tissue cryopreservation (OTC) offers an alternative for those unfit for OC. Despite its experimental label in some societies, emerging data support the efficacy of OTC, with ovarian tissue transplantation (OTT) showing promise in restoring ovarian function. However, the reintroduction of potentially malignant cells during transplantation remains a concern. Overall, while FP offers hope for future parenthood, the intricacies of decision-making and the potential medical, ethical, and cultural challenges underscore the importance of a personalized, multi-disciplinary approach. In this review, guidelines from various societies have been comprehensively reviewed and analyzed to provide insight into the clinical practice of oncofertility.
儿科和青少年肿瘤患者的生育力保存（FP）呈现出癌症治疗需求与生殖愿望之间的复杂相互作用，需要多学科方法。基本准则强调了向 FP 专家早期转介的重要性，以确保及时提供关于卵母细胞和卵巢组织冷冻保存选择的咨询。适当的患者选择和风险评估，考虑内在和外在因素，对于明智地利用资源和获得最佳结果至关重要。癌症治疗的性腺毒性作用对生殖能力构成重大威胁。对于没有伴侣的青春期后青少年，推荐进行卵母细胞冷冻保存（OC）。文化和宗教关注，特别是处女膜完整性问题，影响 FP 决策，需要进行文化敏感的同意过程。卵巢组织冷冻保存（OTC）为不适合 OC 的患者提供了另一种选择。尽管在某些社会中 OTC 被贴上实验性标签，但新兴数据支持 OTC 的疗效，卵巢组织移植（OTT）在恢复卵巢功能方面显示出前景。然而，移植过程中潜在恶性细胞的再引入仍然是一个问题。总体而言，尽管 FP 为未来的父母身份带来了希望，但决策的复杂性以及潜在的医学、伦理和文化挑战突显了个性化、多学科方法的重要性。在这篇综述中，全面审查和分析了来自不同社会的指南，以深入了解肿瘤生育力的临床实践。
