中国人体健康科技促进会生育力保护与保存专业委员会;国际妇科内分泌学会中国妇科内分泌学分会;北京妇产学会内分泌分会;中华预防医学会生育力保护分会;中国妇幼健康研究会生殖内分泌专业委员会;通信作者:阮祥燕,首都医科大学附属北京妇产医院/北京妇幼保健院
收稿日期:
2023-07-27
出版日期:
2023-09-06
发布日期:
2023-09-06
通讯作者:
阮祥燕
E-mail:ruanxiangyan@ccmu.edu.cn
基金资助:
Received:
2023-07-27
Online:
2023-09-06
Published:
2023-09-06
摘要: 早发性卵巢功能不全(premature ovarian insufficiency, POI)是指女性在40岁前出现卵巢功能衰退,POI 可引起女性生育力降低或丧失,同时伴随不同程度的围绝经期及绝经症状提早出现,早绝经相关慢性病风险增加,严重影响患者生活质量和生命健康。保守估计中国每年至少有100万女童与育龄女性因放射治疗(以下简称放疗)、化学药物治疗(以下简称化疗)导致POI风险,这种POI,称之为医源性POI。随着医学技术的发展,科技难关的突破,医源性POI防治问题由不可能变成了可能。卵巢组织冻存移植技术是应用低温生物学原理,原则上,在患者放化疗前将部分卵巢组织取出一部分冷冻保存,待放化疗结束,原发病缓解或临床痊愈,再将冷冻保存的卵巢组织移植回患者自体,这样既可恢复患者的卵巢功能,也同时恢复了患者的生育能力。目前,卵巢组织冻存移植被国际指南一致认为是一项最有前景的需接受放化疗女童与放化疗无法推迟的育龄女性卵巢功能与生育力的保护方法。因此项技术在我国起步较晚,虽众多专家认为此项技术有重要意义,很多医疗单位也在做相关研究,但文献报道有卵巢组织冻存移植成功10例以上、且有孩子诞生的中心只有1个。为指导卵巢组织冻存移植技术在我国临床规范应用,指南工作组通过对医生、患者的问卷调查、现场调查及大量中英文献库的检索,讨论和归纳,最终纳入14 个科学问题、18个推荐,以期为中国同道在临床实践中提供参考。
中图分类号:
中国人体健康科技促进会生育力保护与保存专业委员会, 国际妇科内分泌学会中国妇科内分泌学分会, 北京妇产学会内分泌分会, 中华预防医学会生育力保护分会, 中国妇幼健康研究会生殖内分泌专业委员会. 卵巢组织冻存移植防治医源性早发性卵巢功能不全临床应用指南[J]. 首都医科大学学报, doi: 0.3969/j.issn.1006-7795.2023.05.001.
[1]Webber L, Davies M, Anderson R, et al. ESHRE guideline: management of women with premature ovarian insufficiency[J]. Hum Reprod, 2016, 31(5): 926-937. [2]Giri R, Vincent A J. Prevalence and risk factors of premature ovarian insufficiency/early menopause[J]. Semin Reprod Med, 2020, 38(4/5): 237-246. [3]Rebar R W, Keator C S. Expanding our knowledge of premature ovarian insufficiency[J]. Fertil Steril, 2021, 115(2): 328-329. [4]De Vos M, Devroey P, Fauser B C. Primary ovarian insufficiency[J]. Lancet, 2010, 376(9744): 911-921. [5]Vogt E C, Real F G, Husebye E S, et al. Premature menopause and autoimmune primary ovarian insufficiency in two international multi-center cohorts[J]. Endocr Connect, 2022, 11(5): e220024. [6]WHO. China Source: Globocan 2020 [EB/OL].(2021-03)[2023-06-06]. https://gco.iarc.fr/today/data/factsheets/populations/160-china-fact-sheets.pdf. [7]Anderson R A, Amant F, Braat D, et al. ESHRE guideline: female fertility preservation[J]. Hum Reprod Open, 2020, 2020(4): hoaa052. [8]Practice Committee of the American Society for Reproductive Medicine. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion[J]. Fertil Steril, 2019, 112(6): 1022-1033. [9]University of Oxford. Oxford centre for evidencebased medicine: levels of evidence (March 2009)[EB/OL].(2009-03)[2023-06-06]. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009. [10]首都医科大学附属北京妇产医院, 中国人体健康科技促进会生育力保护与保存专业委员会. 卵巢组织冻存移植技术规范团体标准[J]. 中国全科医学, 2023, 26(23): 2836-2841. [11]国际妇科内分泌学会中国妇科内分泌学分会及共识专家. 卵巢组织冻存与移植中国专家共识[J]. 中国临床医生杂志, 2018, 46(4): 496-500. [12]Ruan X Y. Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology guideline for ovarian tissue cryopreservation and transplantation[J]. Gynecol Endocrinol, 2018, 34(12): 1005-1010. [13]Dolmans M M, Von Wolff M, Poirot C, et al. Transplantation of cryopreserved ovarian tissue in a series of 285 women: a review of five leading European centers[J]. Fertil Steril, 2021, 115(5): 1102-1115. [14]Karavani G, Vedder K, Gutman-Ido E, et al. Prior exposure to chemotherapy does not reduce the in vitro maturation potential of oocytes obtained from ovarian cortex in cancer patients[J/OL]. Hum Reprod. (2023-07-06)[2023-06-06]. https://pubmed.ncbi.nlm.nih.gov/37414543/. [15]Corkum K S, Laronda M M, Rowell E E. A review of reported surgical techniques in fertility preservation for prepubertal and adolescent females facing a fertility threatening diagnosis or treatment[J]. Am J Surg, 2017, 214(4): 695-700. [16]Beckmann M W, Dittrich R, Lotz L, et al. Fertility protection: complications of surgery and results of removal and transplantation of ovarian tissue[J]. Reprod Biomed Online, 2018, 36(2): 188-196. [17]Ruan X Y, Cheng J J, Du J, et al. Analysis of fertility preservation by ovarian tissue cryopreservation in pediatric children in China[J]. Front Endocrinol (Lausanne), 2022, 13: 930786. [18]Cheng J J, Ruan X Y, Du J, et al. Ovarian tissue cryopreservation for a 3-year-old girl with Mosaic Turner syndrome in China: first case report and literature review[J]. Front Endocrinol (Lausanne), 2022, 13: 959912. [19]Khattak H, Malhas R, Craciunas L, et al. Fresh and cryopreserved ovarian tissue transplantation for preserving reproductive and endocrine function: a systematic review and individual patient data meta-analysis[J]. Hum Reprod Update, 2022, 28(3): 400-416. [20]Gellert S E, Pors S E, Kristensen S G, et al. Transplantation of frozenthawed ovarian tissue: an update on worldwide activity published in peer-reviewed papers and on the Danish cohort[J]. J Assist Reprod Genet, 2018, 35(4): 561-570. [21]Dolmans M M, Iwahara Y, Donnez J, et al. Evaluation of minimal disseminated disease in cryopreserved ovarian tissue from bone and soft tissue sarcoma patients[J]. Hum Reprod, 2016, 31(10): 2292-2302. [22]Shapira M, Raanani H, Barshack I, et al. First delivery in a leukemia survivor after transplantation of cryopreserved ovarian tissue, evaluated for leukemia cells contamination[J]. Fertil Steril, 2018, 109(1): 48-53. [23]Nurmio M, Asadi-Azarbaijani B, Hou M, et al. Effect of previous alkylating agent exposure on follicle numbers in cryopreserved prepubertal and young adult ovarian tissue after long-term xenografting[J]. Cancers (Basel), 2022, 14(2): 399. [24]Chevillon F, Clappier E, Arfeuille C, et al. Minimal residual disease quantification in ovarian tissue collected from patients in complete remission of acute leukemia[J]. Blood, 2021, 137(12): 1697-1701. [25]Zver T, Frontczak S, Poirot C, et al. Minimal residual disease detection by multicolor flow cytometry in cryopreserved ovarian tissue from leukemia patients[J]. J Ovarian Res, 2022, 15(1): 9. [26]Shirai R, Osumi T, Keino D, et al. Minimal residual disease detection by mutation-specific droplet digital PCR for leukemia/lymphoma[J]. Int J Hematol, 2023, 117(6): 910-918. [27]Dolmans M M, Donnez J, Cacciottola L. Fertility preservation: the challenge of freezing and transplanting ovarian tissue[J]. Trends Mol Med, 2021, 27(8): 777-791. [28]Cadenas J, La Cour Poulsen L, Mamsen L S, et al. Future potential of in vitro maturation including fertility preservation[J]. Fertil Steril, 2023, 119(4): 550-559. [29]Practice Committees of the American Society for Reproductive Medicine, The Society of Reproductive Biologists and Technologists, The Society for Assisted Reproductive Technology. in vitro maturation: a committee opinion[J]. Fertil Steril, 2021, 115(2): 298-304. [30]Braam S C, Ho V N A, Pham T D, et al. In-vitro maturation versus IVF: a cost-effectiveness analysis[J]. Reprod Biomed Online, 2021, 42(1): 143-149. [31]Silber S J, Goldsmith S, Castleman L, et al. In-vitro maturation and transplantation of cryopreserved ovary tissue: understanding ovarian longevity[J]. Reprod Biomed Online, 2022, 44(3): 504-514. [32]Ruan X, Cheng J, Korell M, et al. Ovarian tissue cryopreservation and transplantation prevents iatrogenic premature ovarian insufficiency: first 10 cases in China[J]. Climacteric, 2020, 23(6): 574-580. [33]Byrne J, Grabow D, Campbell H, et al. PanCareLIFE: the scientific basis for a european project to improve longterm care regarding fertility, ototoxicity and healthrelated quality of life after cancer occurring among children and adolescents[J]. Eur J Cancer, 2018, 103: 227-237. [34]Poirot C, Abirached F, Prades M, et al. Induction of puberty by autograft of cryopreserved ovarian tissue[J]. Lancet, 2012, 379(9815): 588. [35]Ernst E, Kjærsgaard M, Birkebæk N H, et al. Case report: stimulation of puberty in a girl with chemo- and radiation therapy induced ovarian failure by transplantation of a small part of her frozen/thawed ovarian tissue[J]. Eur J Cancer, 2013, 49(4): 911-914. [36]Rodriguez-Wallberg K A, Milenkovic M, Papaikonomou K, et al. Successful pregnancies after transplantation of ovarian tissue retrieved and cryopreserved at time of childhood acute lymphoblastic leukemia - a case report[J]. Haematologica, 2021, 106(10): 2783-2787. [37]Poirot C, Brugieres L, Yakouben K, et al. Ovarian tissue cryopreservation for fertility preservation in 418 girls and adolescents up to 15 years of age facing highly gonadotoxic treatment. Twenty years of experience at a single center[J]. Acta Obstet Gynecol Scand, 2019, 98(5): 630-637. [38]Dolmans M M, Hossay C, Nguyen T Y T, et al. Fertility preservation: how to preserve ovarian function in children, adolescents and adults[J]. J Clin Med, 2021, 10(22): 5247. [39]Demeestere I, Simon P, Dedeken L, et al. Live birth after autograft of ovarian tissue cryopreserved during childhood[J]. Hum Reprod, 2015, 30(9): 2107-2109. [40]Matthews S J, Picton H, Ernst E, et al. Successful pregnancy in a woman previously suffering from β-thalassemia following transplantation of ovarian tissue cryopreserved before puberty[J]. Minerva Ginecol, 2018, 70(4): 432-435. [41]Colmorn L B, Pedersen A T, Larsen E C, et al. Reproductive and endocrine outcomes in a cohort of Danish women following auto-transplantation of frozen/thawed ovarian tissue from a single center[J]. Cancers (Basel), 2022, 14(23): 5873. [42]Ruan X, Du J, Lu D, et al. First pregnancy in China after ovarian tissue transplantation to prevent premature ovarian insufficiency[J]. Climacteric, 2021, 24(6): 624-628. [43]Ruan X, Du J, Lu D, et al. First live birth in China after cryopreserved ovarian tissue transplantation to prevent premature ovarian insufficiency[J]. Climacteric, 2022, 25(4): 421-424. [44]Lotz L, Bender-Liebenthron J, Dittrich R, et al. Determinants of transplantation success with cryopreserved ovarian tissue: data from 196 women of the FertiPROTEKT network[J]. Hum Reprod, 2022, 37(12): 2787-2796. [45]金凤羽, 阮祥燕, 杜娟, 等. 中国首个卵巢组织冻存库冻存患者特征及冻存效果分析[J]. 首都医科大学学报, 2021, 42(4): 521-525. [46]阮祥燕, 程姣姣, 杜娟, 等. 子宫内膜癌卵巢组织冻存自体移植1例报道[J]. 中华生殖与避孕杂志, 2021, 41(7): 644-649. [47]Dittrich R, Hackl J, Lotz L, et al. Pregnancies and live births after 20 transplantations of cryopreserved ovarian tissue in a single center[J]. Fertil Steril, 2015, 103(2): 462-468. [48]Khiat S, Bottin P, Saïas-Magnan J, et al. Fertility preservation strategies for rectal cancer in reproductive-age women[J]. Future Oncol, 2019, 15(22): 2635-2643. [49]Taylor H S, Kotlyar A M, Flores V A. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations[J]. Lancet, 2021, 397(10276): 839-852. [50]Donnez J, Squifflet J, Dolmans M M, et al. Orthotopic transplantation of fresh ovarian cortex: a report of two cases[J]. Fertil Steril, 2005, 84(4): 1018.e1-1018.e3. [51]Sänger N, Menabrito M, Di Spiezo Sardo A, et al. Fertility preservation counselling for women with endometriosis: a European online survey[J]. Arch Gynecol Obstet, 2023, 307(1): 73-85. [52]Calagna G, Corte L D, Giampaolino P, et al. Endometriosis and strategies of fertility preservation: a systematic review of the literature[J]. Eur J Obstet Gynecol Reprod Biol, 2020, 254: 218-225. [53]Oktay K, Oktem O. Ovarian cryopreservation and transplantation for fertility preservation for medical indications: report of an ongoing experience[J]. Fertil Steril, 2010, 93(3): 762-768. [54]Schallmoser A, Einenkel R, Färber C, et al. Cryostorage of human ovarian tissue: evaluating the storage and disposal pattern over a 22-year period in 2475 patients[J/OL]. Reprod Biomed Online, 2023: 103239. (2023-05-27)[2023-06-06]. https://pubmed.ncbi.nlm.nih.gov/37400319/. [55]Fabbri R, Vicenti R, Magnani V, et al. Cryopreservation of ovarian tissue in breast cancer patients: 10 years of experience[J]. Future Oncol, 2012, 8(12): 1613-1619. [56]Donnez J, Dolmans M M. Fertility preservation in women[J]. N Engl J Med, 2017, 377(17): 1657-1665. [57]Von Wolff M, Sänger N, Liebenthron J. Is ovarian tissue cryopreservation and transplantation still experimental? It is a matter of female age and type of cancer[J]. J Clin Oncol, 2018, 36(33): 3340-3341. [58]Lambertini M, Del Mastro L, Pescio M C, et al. Cancer and fertility preservation: international recommendations from an expert meeting[J]. BMC Med, 2016, 14: 1. [59]Ulrich N D, Raja N S, Moravek M B. A review of fertility preservation in patients with breast cancer[J]. Best Pract Res Clin Obstet Gynaecol, 2022, 82: 60-68. [60]中国人体健康科技促进会生育力保护与保存专业委员会, 国际妇科内分泌学会中国妇科内分泌学分会. 造血干细胞移植女童患者生育力保护中国专家共识[J]. 中国临床医生杂志, 2022, 50(9): 1027-1032. [61]Ruan X. Expert consensus on fertility preservation in hematopoietic stem cell transplantation in girls in China[J]. Gynecol Endocrinol, 2023, 39(1): 2146671. [62]Biasin E, Salvagno F, Berger M, et al. Ovarian tissue cryopreservation in girls undergoing haematopoietic stem cell transplant: experience of a single centre[J]. Bone Marrow Transplant, 2015, 50(9): 1206-1211. [63]Torella M, Riemma G, De Franciscis P, et al. Serum anti-Müllerian hormone levels and risk of premature ovarian insufficiency in female childhood cancer survivors: systematic review and network meta-analysis[J]. Cancers (Basel), 2021, 13(24): 6331. [64]Wikander I, Lundberg F E, Nilsson H, et al. A prospective study on fertility preservation in prepubertal and adolescent girls undergoing hematological stem cell transplantation[J]. Front Oncol, 2021, 11: 692834. [65]Kyono K, Hashimoto T, Toya M, et al. A transportation network for human ovarian tissue is indispensable to success for fertility preservation[J]. J Assist Reprod Genet, 2017, 34(11): 1469-1474. [66]Ozimek N, Salama M, Woodruff T K. National oncofertility registries around the globe: a pilot survey[J]. Front Endocrinol (Lausanne), 2023, 14: 1148314. [67]Von Wolff M, Dittrich R, Liebenthron J, et al. Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women[J]. Reprod Biomed Online, 2015, 31(5): 605-612. [68]Ataman L M, Rodrigues J K, Marinho R M, et al. Creating a global community of practice for oncofertility[J]. J Glob Oncol, 2016, 2(2): 83-96. [69]Woodruff T K. The Oncofertility Consortium-addressing fertility in young people with cancer[J]. Nat Rev Clin Oncol, 2010, 7(8): 466-475. [70]Liebenthron J, Montag M, Reinsberg J, et al. Overnight ovarian tissue transportation for centralized cryobanking: a feasible option[J]. Reprod Biomed Online, 2019, 38(5): 740-749. [71]Isachenko E, Isachenko V, Nawroth F, et al. Effect of long-term exposure at suprazero temperatures on activity and viability of human ovarian cortex[J]. Fertil Steril, 2009, 91(4 Suppl): 1556-1559. [72]Liebenthron J, Montag M. Chapter 15 development of a nationwide network for ovarian tissue cryopreservation[J]. Methods Mol Biol, 2017, 1568: 205-220. |
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