von Wolff Michael, Imboden Sara, Stute Petra
Division of Gynaecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital, Friedbühlstrasse 19, 3010, Bern, Switzerland.
Department of Pelvic Cancer, Unit of Gynecologic Oncology, Karolinska University Hospital, Stockholm, Sweden.
Arch Gynecol Obstet. 2025 Jul 12. doi: 10.1007/s00404-025-08104-5.
To date, fertility preservation has mainly been offered to patients prior to gonadotoxic treatment. Ovarian reserve is assessed by analysing blood levels of anti-müllerian hormone (AMH), and gonadal cells or tissue are cryopreserved if indicated and requested by the patient. If primary fertility preservation (Primary FertiProtekt) before gonadotoxic treatment was not performed or was ineffective, secondary fertility preservation should be considered approximately one year after treatment based on a more extensive ovarian reserve analysis including menstrual cycle pattern, antral follicle count, and serum levels of AMH, estradiol and follicle stimulating hormone. Ovarian reserve analysis is also required to consider endocrine treatment in (pre) menopausal patients. Both approaches require the fertility preservation treatment to be tailored to the ovarian reserve status, type of gonadotoxic therapy. For secondary fertility preservation (Secondary FertiProtekt), oocyte freezing may be considered if ovarian reserve is not too low. Monthly treatment cycles, natural cycle or minimal stimulation protocols and follicle aspiration without anesthesia should be preferred. Menopause care management (MenoProtekt) involves acute menopausal symptom relief and prevention of chronic non-communicable diseases. The management needs to be individualized based on type of disease (hormone-dependent or -independent).
迄今为止，生育力保存主要是在患者接受性腺毒性治疗前提供。通过分析抗苗勒管激素（AMH）的血液水平来评估卵巢储备，如果患者有指征并提出要求，则对性腺细胞或组织进行冷冻保存。如果在性腺毒性治疗前未进行初级生育力保存（初级FertiProtekt）或其无效，则应在治疗后约一年，基于更广泛的卵巢储备分析，包括月经周期模式、窦卵泡计数以及AMH、雌二醇和促卵泡生成素的血清水平，考虑进行次级生育力保存。对于（围）绝经期患者，考虑内分泌治疗时也需要进行卵巢储备分析。这两种方法都要求生育力保存治疗要根据卵巢储备状态、性腺毒性治疗类型进行调整。对于次级生育力保存（次级FertiProtekt），如果卵巢储备不是过低，可以考虑卵母细胞冷冻。应优先选择每月治疗周期、自然周期或最小刺激方案以及无需麻醉的卵泡抽吸。绝经护理管理（MenoProtekt）包括缓解急性绝经症状和预防慢性非传染性疾病。管理需要根据疾病类型（激素依赖性或非依赖性）进行个体化。
