女性化疗患者的生育能力保护

Fertility preservation in female patients before and during chemotherapy

化疗是治疗恶性肿瘤的重要措施,能够显著延长患者的生存期,改善预后。化疗药物会损伤女性的卵巢功能,可导致生育能力下降、卵巢早衰,其中烷化剂类造成的损伤最严重。如何保护女性化疗患者的生育能力,是科研及临床的热点问题。目前常用的方法包括:(1)激素类药物:化疗前及化疗期间使用促性腺激素释放激素激动剂等可减少化疗药对卵巢的损伤;(2)冷冻技术:包括卵巢组织、卵母细胞、胚胎冷冻,化疗结束后移植回体内。至今卵巢组织的复苏移植已使16位女性妊娠;胚胎冷冻是发展最为成熟的冷冻技术,妊娠率较高,但可能延误肿瘤治疗,并且受各种社会因素影响;卵母细胞冷冻则适用于无配偶及青春期前的女性患者。本文将就保护女性化疗患者生育能力各项技术的研究进展、效果及存在的问题进行综述。

Chemotherapy is an important treatment for cancer, which can improve the prognosis. The aggressive chemotherapy often causes ovarian damage and raises risks of ovarian failure and infertility. The damage caused by alkylating agents is most serious. Fertility preservation in female patients before and during chemotherapy has been a hot issue in recent years. Options for fertility preservation include. （1） using medication e.g. gonadotrophin releasing hormone analogues tO reduce chemotherapy-induced ovarian damage~ （2） cryopreservation of ovarian tissue, oocytes or embryoes before the chemotherapy, and reimplantation after the cancer treatment. Up to now, 16 female patients have achieved pregnancies after ovarian tissue reimplantation. Embryo cryopreservation is a well-established method with a good success rate, but it may delay cancer treatment and is only applicable to patients with stable partners. Moreover oocyte cryopreservation could be applied to patients without spouse or prepubertal girl. The present review gives an overview about the commonly used fertility preserving methods as well as the unsolved issues.