ESHRE guideline: female fertility preservation.
ESHRE guideline: female fertility preservation.
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DOI：
10.1093/hropen/hoaa052
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发表时间：
2020
影响因子：
8.3
通讯作者：
Vermeulen N
中科院分区：
文献类型：
--
作者：
ESHRE Guideline Group on Female Fertility Preservation;Anderson RA;Amant F;Braat D;D'Angelo A;Chuva de Sousa Lopes SM;Demeestere I;Dwek S;Frith L;Lambertini M;Maslin C;Moura-Ramos M;Nogueira D;Rodriguez-Wallberg K;Vermeulen N
根据文献中可获得的最佳证据，在保留生育能力(FP)方面，建议对女性和变性人男性采取什么管理措施？ESHRE关于保持女性生育力的指南就护理组织、信息提供和支持、计划生育前评估、计划生育干预和治疗后护理提出了78项建议。文中还讨论了FP的最新进展。在过去的二十年里，由于人们日益认识到潜在的生育能力丧失作为癌症和其他严重疾病治疗的重大影响的重要性，以及使卵母细胞玻璃化冷冻和卵巢组织冷冻保存(OTC)用于后续自体移植的技术的发展，FP领域得到了巨大的发展。这导致了为年轻女性提供广泛的、但不均衡的计划生育。该指南是根据制定ESHRE指南的结构化方法制定的。在一组专家提出关键问题后，进行了文献搜索和评估。截至2019年11月1日发表的英文论文被纳入审查范围。根据收集的证据，制定和讨论建议，直到指导小组内部达成共识。在草案定稿后，组织了一次利益攸关方审查。指南小组和ESHRE执行委员会批准了最终版本。该指南旨在帮助提供者满足不同患者群体对FP方案日益增长的需求，包括那些接受性腺激素治疗的癌症患者、接受性腺激素治疗的良性疾病患者或那些易导致卵巢早衰的遗传疾病患者、变性人男性(出生时指定为女性)以及因年龄原因失去生育能力而要求卵母细胞冷冻保存的女性。该指南就信息提供和支持、计划生育前评估、计划生育干预和治疗后护理提出了78项建议，其中50项循证建议--其中31项是强有力的建议，19项是薄弱的--25项良好做法要点和3项仅限研究的建议。在基于证据的建议中，1项得到高质量证据的支持，3项得到中等质量证据的支持，17项得到低质量证据的支持，29项得到极低质量证据的支持。为了支持未来在女性计划生育领域的研究，提供了一系列研究建议。在FP患者中，包括的大多数干预措施没有得到很好的研究。由于一些干预措施，如卵母细胞和胚胎冷冻保存，已经很好地用于治疗不孕不育，因此可以推断技术方面、可行性和结果。对于其他干预措施，如OTC和IVM，需要更多的证据，特别是在对FP患者应用这些技术后的妊娠结局。这类未来的研究可能需要修订目前的建议。该指南根据目前可用的最佳证据，为临床医生提供了关于女性FP最佳实践的明确建议。此外，还提供了一系列研究建议，以促进对FP的进一步研究。该指南是由ESHRE制定和资助的，包括与指南会议、文献检索和指南传播相关的费用。指导小组成员没有收到付款。R.A.A.报告来自罗氏诊断公司的个人费用和非财务支持，来自Ferring PharmPharmticals、IBSA和Merck Serono的个人费用，以及提交的工作之外的个人费用；D.B.报告来自Merck Serono和Goodlife的赠款，提交的工作之外；I.D.报告来自罗氏的咨询费和来自诺华的演讲者费用；M.L.报告来自罗氏、诺华、辉瑞、礼来、武田和Theramex的个人费用。其他作者没有利益冲突要申报。本指南代表了ESHRE的观点，这些观点是在认真考虑编制时可获得的科学证据后得出的。在某些方面缺乏科学证据的情况下，相关的ESHRE利益攸关方达成了共识。遵守这些临床实践指南不能保证成功或特定的结果，也不能建立护理标准。临床实践指南不能取代对每个个体的临床判断的需要，也不能取代基于地点和设施类型的变化。ESHRE对临床实践指南不作任何明示或暗示的保证，并明确排除对特定用途或目的的适销性和适合性的任何保证。(完整的免责声明可在www.eshre.eu/Guiders上查阅。)†ESHRE页面的内容不会进行外部同行审查。该手稿已获得ESHRE执行委员会的批准。
What is the recommended management for women and transgender men with regards to fertility preservation (FP), based on the best available evidence in the literature? The ESHRE Guideline on Female Fertility Preservation makes 78 recommendations on organization of care, information provision and support, pre-FP assessment, FP interventions and after treatment care. Ongoing developments in FP are also discussed. The field of FP has grown hugely in the last two decades, driven by the increasing recognition of the importance of potential loss of fertility as a significant effect of the treatment of cancer and other serious diseases, and the development of the enabling technologies of oocyte vitrification and ovarian tissue cryopreservation (OTC) for subsequent autografting. This has led to the widespread, though uneven, provision of FP for young women. The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 November 2019 and written in English were included in the review. Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee. This guideline aims to help providers meet a growing demand for FP options by diverse groups of patients, including those diagnosed with cancer undergoing gonadotoxic treatments, with benign diseases undergoing gonadotoxic treatments or those with a genetic condition predisposing to premature ovarian insufficiency, transgender men (assigned female at birth), and women requesting oocyte cryopreservation for age-related fertility loss. The guideline makes 78 recommendations on information provision and support, pre-FP assessment, FP interventions and after treatment care, including 50 evidence-based recommendations—of which 31 were formulated as strong recommendations and 19 as weak—25 good practice points and 3 research only recommendations. Of the evidence-based recommendations, 1 was supported by high-quality evidence, 3 by moderate-quality evidence, 17 by low-quality evidence and 29 by very low-quality evidence. To support future research in the field of female FP, a list of research recommendations is provided. Most interventions included are not well studied in FP patients. As some interventions, e.g. oocyte and embryo cryopreservation, are well established for treatment of infertility, technical aspects, feasibility and outcomes can be extrapolated. For other interventions, such as OTC and IVM, more evidence is required, specifically pregnancy outcomes after applying these techniques for FP patients. Such future studies may require the current recommendations to be revised. The guideline provides clinicians with clear advice on best practice in female FP, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in FP. The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. R.A.A. reports personal fees and non-financial support from Roche Diagnostics, personal fees from Ferring Pharmaceuticals, IBSA and Merck Serono, outside the submitted work; D.B. reports grants from Merck Serono and Goodlife, outside the submitted work; I.D. reports consulting fees from Roche and speaker’s fees from Novartis; M.L. reports personal fees from Roche, Novartis, Pfizer, Lilly, Takeda, and Theramex, outside the submitted work. The other authors have no conflicts of interest to declare. This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.) †ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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