自体卵巢皮质移植使癌症患者恢复生育力

加州圣巴巴拉——加州大学洛杉矶分校主办的体外受精-胚胎移植会议上公布的一项西班牙研究显示，欧洲已有一些癌症存活女性通过卵巢皮质原位移植恢复了生育能力。

借助这项技术，癌症存活女性至少孕育出了21名活产儿。

这项瓦伦西亚维持生育力研究由西班牙巴伦西亚大学医学院院长兼妇产科教授Antonio Pellicer博士及其同事进行，纳入超过600例诊断癌症时已取出卵巢皮质的患者。会上报告的数据来自2005年以来接受治疗的583例患者，其中55%被诊断为乳腺癌。

一些患者在接受自体卵巢皮质移植后恢复正常月经和生育力。共有16例妊娠和3例活产，一些是通过体外受精实现，另一些是自然受孕的结果。加上之前来自法国、德国、丹麦、比利时和其他国家的研究报道，目前至少有21名(也可能是≥23名)活产儿通过此技术出生。

目前的问题在于缺乏连续随访或可供客观分析这些新生儿的数据。目前不清楚失败的例数，因为既没有相关登记库，也缺乏真实数据。

虽然该技术的可行性和实用性仍不十分明确，但其为患有其他类型癌症的青春期前女孩和青少年以及成人癌症患者提供了希望。基于对所采集的卵巢组织的组织学和免疫学评估结果，目前认为该技术可安全应用于乳腺癌、霍奇金淋巴瘤和非霍奇金淋巴瘤患者，但在用于白血病患者时存在安全隐患，因为转移细胞可通过血流循环至卵巢。此外，由于尤因肉瘤也具有高度转移性，因此也是该技术的禁忌证。

Pellicer博士在回答一个与会者提问时表示，在癌症治疗前取出卵巢皮质可能会降低生育力，而不是增强，因此一些癌症患者在疾病缓解后可自然受孕。

Pellicer博士声明无相关经济利益冲突。

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By: BETSY BATES, Ob.Gyn. News Digital Network

SANTA BARBARA, CALIF. – Ovarian cortex orthotransplantation has resulted in the live births of at least 21 babies to cancer survivors in Europe, where the technique was pioneered and is being refined, Dr. Antonio Pellicer reported at a meeting on in vitro fertilization and embryo transfer.

Unlike the freezing of oocytes or embryos to preserve potential fertility, which requires ovarian stimulation, the ovarian cortex can be harvested from a cancer patient without delay, permitting immediate initiation of chemotherapy and/or radiation therapy. The tissue is cryopreserved until the patient is in remission.

If cancer treatment results in premature ovarian failure and the patient wishes to become pregnant, her autologous ovarian cortex can then be reintroduced.
 
Ovarian function generally resumes within 3-4 months, said Dr. Pellicer, professor of obstetrics and gynecology and dean of the medical school at the University of Valencia (Spain). Follicle stimulating hormone rates do not reach normal levels, but are sufficient in many cases for resumption of menses and pregnancy, either naturally or through assisted reproductive techniques.

The technique is currently believed to be safe for breast cancer patients and those with Hodgkin’s and non-Hodgkin’s lymphoma, based on histologic and immunologic evaluations of harvested ovarian tissue, Dr. Pellicer said at the meeting, which was sponsored by the University of California, Los Angeles.

It is considered unsafe for patients with leukemia, as metastatic cells might well circulate through the bloodstream to the ovaries. Because of its highly metastatic potential, Ewing’s sarcoma is also considered a contraindication for the procedure, according to Dr. Pellicer.

The technique offers hope, potentially, for prepubertal girls and adolescents with other types of cancer, as well as adult cancer patients, although much remains unknown about the viability and usefulness of the treatment, explained Dr. Pellicer.

At the Valencia Program of Fertility Preservation, more than 600 cancer patients from across Spain have undergone removal of the ovarian cortex around the time of diagnosis, said Dr. Pellicer.

He reported on results in 583 of those patients who were treated since 2005, 55% of whom had been diagnosed with breast cancer.

Regular menses and fertility were restored in some patients who received ovarian autografts, said Dr. Pellicer. In all, 16 pregnancies and 3 live births have occurred, some following in vitro fertilization and some following natural conception.

Those results, along with published studies from programs in France, Germany, Denmark, Belgium, and other countries, indicate that at least 21 and perhaps 23 or more live births have resulted from the technique.

The problem, as Dr. Pellicer sees it, is a lack of cohesive follow-up or evidence that would put those births into perspective.

"We don’t know the number of failed attempts," he said. "There are no registries. There are no real data. Are we doing something which is really helpful? Or are the unsuccessful cases more [typical] than the successful cases?"

"This is a concern to me," he said.

Responding to a question from an audience member, Dr. Pellicer acknowledged that the removal of one ovarian cortex prior to cancer treatment might diminish fertility potential rather than enhance it, because some cancer patients conceive naturally following remission.

Dr. Pellicer reported that he had no relevant financial relationships to disclose.