PDF(Pubmed)
Abstract：
To ensure patient care in an oncological fertility preservation (FP) programme, specialists must provide technology that best suits the patients\' clinical conditions. In vitro oocyte maturation (IVM) and ovarian tissue cryopreservation (OTC) are possible fertility preservation treatments for women in need of urgent oncological treatment. IVM consists of the retrieval of immature oocytes from small antral follicles, with no or minimal ovarian stimulation by gonadotropins. Therefore, IVM has become a pertinent option for fertility preservation, especially for cases whereby ovarian stimulation is unfeasible or contra-indicated. Existing data on immature oocytes, retrieved transvaginally (OPU-IVM) or extracted from ovarian tissue \'ex vivo\' (OTO-IVM), are still limited on technical consistency, efficacy, and safety. The present retrospective cohort study includes 89 women undergoing fertility preservation using IVM methodologies and 26 women undergoing ovarian stimulation (OS) in concomitant period. In total, 533 immature oocytes were collected from IVM patients, achieving a maturation rate of 57% and 70% in OTO-IVM and 73% and 82% in OPU-IVM at 24 h and 48 h in culture, respectively. The observed high maturation rates might be due to the use of patients\' serum in its innate status, i.e., without heat-inactivation. This permitted 7.6 ± 5.7 and 4.6 ± 4.9 oocytes to be vitrified in OTO-IVM and OPU-IVM, respectively, compared to 6.8 ± 4.6 from OS patients. Regarding OS patients, two of them underwent embryo transfer following the insemination of warmed oocytes after complete remission, resulting in a single live birth from one patient. Upon follow-up of two OTO-IVM patients after the termination of their oncological treatment, a total of 11 warmed oocytes lead to a transfer of a single embryo, but pregnancy was not achieved. From OPU-IVM, six embryos were transferred in three patients 4.25 years after oocyte vitrification, leading to the live birth of a healthy boy. The present case of live birth is among the first cases reported so far and supports the notion that IVM might be a relevant and safe FP option for cancer patients when oocyte preservation is required but ovarian stimulation is contra-indicated.
摘要：
为了确保在肿瘤生育保护（FP）计划中对患者进行护理，专家必须提供最适合患者临床条件的技术。对于需要紧急肿瘤治疗的女性，体外卵母细胞成熟（IVM）和卵巢组织冷冻保存（OTC）是可能的生育力保存治疗。IVM包括从小的窦卵泡中取出未成熟的卵母细胞，没有或很少有促性腺激素刺激卵巢。因此,IVM已成为保留生育能力的相关选择，特别是对于卵巢刺激不可行或禁忌的病例。未成熟卵母细胞的现有数据，经阴道取回(OPU-IVM)或从“离体”卵巢组织提取(OTO-IVM)，在技术一致性方面仍然有限，功效,和安全。本回顾性队列研究包括89名使用IVM方法进行生育力保存的妇女和26名同时进行卵巢刺激（OS）的妇女。总的来说,从IVM患者收集533个未成熟卵母细胞，在培养24h和48h时，OTO-IVM的成熟率为57％和70％，OPU-IVM的成熟率为73％和82％，分别。观察到的高成熟率可能是由于使用患者血清在其先天状态，即，没有热灭活。这允许7.6±5.7和4.6±4.9卵母细胞在OTO-IVM和OPU-IVM中玻璃化，分别,与OS患者的6.8±4.6相比。关于OS患者，其中两个在完全缓解后，在温暖的卵母细胞授精后进行了胚胎移植，导致一名患者一次活产。在终止肿瘤治疗后对两名OTO-IVM患者进行随访时，总共11个温暖的卵母细胞导致单个胚胎的转移，但是没有怀孕。从OPU-IVM，三个患者在卵母细胞玻璃化4.25年后转移了六个胚胎，导致一个健康男孩的活产。目前的活产病例是迄今为止报道的第一批病例之一，并支持以下观点：当需要保存卵母细胞但禁止卵巢刺激时，IVM可能是癌症患者的相关且安全的FP选择。
