Cathelain Alice, Keller Laura, Collinet Pierre, Kerbage Yohan, d'Orazio Emmanuelle, Piver Pascal, Pigny Pascal, Decanter Christine
Department of Assisted Reproductive Technologies and Fertility Preservation, Jeanne de Flandre Hospital, CHU Lille, 59000, Lille, France.
Department of Gynaecological Surgery, CHU Lille, 59000, Lille, France.
Arch Gynecol Obstet. 2024 Dec;310(6):3209-3218. doi: 10.1007/s00404-024-07810-w. Epub 2024 Nov 30.
Ovarian tissue cryopreservation (OTC) is recommended by scientific societies for women undergoing highly gonadotoxic cancer treatments. Following transplantation, the restoration of ovarian function is typically characterised by the resumption of spontaneous menstruation. Yet, a few studies have looked at the longitudinal hormonal variations following transplantation. This study aims to investigate the fluctuation of gonadotropins and granulosa/theca cells secretions during the interval between ovarian transplantation and the recovery of menstrual function in two young women with no residual ovarian activity.
We selected two patients diagnosed with Hodgkin's lymphoma, initially referred for OTC at the ages of 19 and 15, respectively, and who had both undergone two consecutive stem cell transplants due to recurrent disease episodes. Both patients presented with premature ovarian failure and returned at ages 29 and 26, respectively, for ovarian cortex transplantation. Hormonal secretions and menstrual function were closely monitored both prior and in the months following the ovarian transplantation.
Menstruation resumed at 7 and 5 months post-transplantation, respectively. FSH and LH levels significantly decreased as early as 1 and 3 months before the first menstruation. As for ovarian hormonal secretion, AMH, measured with an ultra-sensitive assay ("pico AMH"), and Inhibin B were the first to increase, starting 1 month before the resumption of menstruation. Subsequently, AMH levels consistently remained very low throughout the follow-up, as did androgens, which showed a slight increase after the graft but remained at postmenopausal levels.
Pico AMH, measured by an ultra-sensitive assay, Inhibin B and estradiol are the first ovarian hormones to be secreted following an ovarian graft, with levels rising 1 month prior the return of menstruation. However, the earliest hormonal indicators of graft success are the significant drops in FSH and LH levels, accompanied by a rise in estradiol levels, which occur 1-3 months before menstruation resumes.
科学协会建议对接受高性腺毒性癌症治疗的女性进行卵巢组织冷冻保存（OTC）。移植后，卵巢功能的恢复通常以自发月经恢复为特征。然而，很少有研究关注移植后的纵向激素变化。本研究旨在调查两名无残余卵巢活动的年轻女性在卵巢移植至月经功能恢复期间促性腺激素和颗粒细胞/卵泡膜细胞分泌的波动情况。
我们选择了两名被诊断为霍奇金淋巴瘤的患者，她们最初分别在19岁和15岁时因OTC前来就诊，且均因疾病复发接受了两次连续的干细胞移植。两名患者均出现过早卵巢功能衰竭，分别在29岁和26岁时返回进行卵巢皮质移植。在卵巢移植前及移植后的几个月内密切监测激素分泌和月经功能。
移植后分别在7个月和5个月恢复月经。早在第一次月经前1个月和3个月，促卵泡生成素（FSH）和促黄体生成素（LH）水平就显著下降。至于卵巢激素分泌，用超灵敏检测法（“皮克AMH”）测量的抗缪勒管激素（AMH）和抑制素B最早在月经恢复前1个月开始增加。随后，在整个随访期间，AMH水平一直非常低，雄激素也是如此，雄激素在移植后略有增加，但仍处于绝经后水平。
通过超灵敏检测法测量的皮克AMH、抑制素B和雌二醇是卵巢移植后最早分泌的卵巢激素，其水平在月经恢复前1个月升高。然而，移植成功的最早激素指标是FSH和LH水平的显著下降，同时雌二醇水平升高，这发生在月经恢复前1 - 3个月。
