Cancer treatment and gonadal function: experimental and established strategies for fertility preservation in children and young adults
Cancer treatment and gonadal function: experimental and established strategies for fertility preservation in children and young adults
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DOI：
10.1016/s2213-8587(15)00039-x
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发表时间：
2015-07-01
影响因子：
44.5
通讯作者：
Wallace, W. Hamish B.
中科院分区：
文献类型：
--
作者：
Anderson, Richard A.;Mitchell, Rod T.;Wallace, W. Hamish B.
保护性腺功能对于接受治疗的男女和所有年龄段的癌症幸存者的长期健康而言是一个重要的优先事项。失去生育机会是男性和女性癌症幸存者最关心的问题，但性腺损伤对内分泌的影响同样对长期健康和福祉至关重要。一些生育力保存技术，例如精液和胚胎冷冻保存，已在成人中建立并取得成功，卵母细胞玻璃化冷冻的发展极大地提高了冷冻保存未受精卵母细胞的潜力。尽管建议所有青春期男性患者使用精子库，但儿科肿瘤中心并未普遍实行精子库，而且很少有适合青少年的设施。所有保留生育能力的方法都会对儿童和青少年产生特定的挑战，包括伦理、实践和科学问题。对于年轻女性来说，卵巢皮质组织的冷冻保存并随后进行替换已导致至少 40 例活产，但在大多数国家仍被视为实验性的。对于青春期前的男孩，一些中心提供睾丸活检冷冻保存，但这些组织将来如何使用尚不清楚，而且迄今为止没有证据表明可以恢复生育能力。对于男女来说，这些方法都涉及侵入性手术，并且在血液学和其他恶性肿瘤中存在不确定的组织污染风险。所有这些方法的决策都需要评估个人丧失生育能力的风险，并且是在情绪困扰时做出的。该专业的发展需要更好地为患者及其医疗团队提供信息，并改进服务提供，以适应技术和科学的进步。
Preservation of gonadal function is an important priority for the long-term health of cancer survivors of both sexes and all ages at treatment. Loss of opportunity for fertility is a prime concern in both male and female cancer survivors, but endocrine effects of gonadal damage are likewise central to long-term health and wellbeing. Some fertility preservation techniques, such as semen and embryo cryopreservation, are established and successful in adults, and development of oocyte vitrification has greatly improved the potential to cryopreserve unfertilised oocytes. Despite being recommended for all pubertal male patients, sperm banking is not universally practised in paediatric oncology centres, and very few adolescent-friendly facilities exist. All approaches to fertility preservation have specific challenges in children and teenagers, including ethical, practical, and scientific issues. For young women, cryopreservation of ovarian cortical tissue with later replacement has resulted in at least 40 livebirths, but is still regarded as experimental in most countries. For prepubertal boys, testicular biopsy cryopreservation is offered in some centres, but how that tissue might be used in the future is unclear, and so far no evidence suggests that fertility can be restored. For both sexes, these approaches involve an invasive procedure and have an uncertain risk of tissue contamination in haematological and other malignancies. Decision making for all these approaches needs assessment of the individual's risk of fertility loss, and is made at a time of emotional distress. Development of this specialty needs better provision of information for patients and their medical teams, and improvements in service provision, to match technical and scientific advances.