PDF(Pubmed)
Abstract：
There is a global trend of declining fertility among people of childbearing age and mankind is confronted with great challenges of fertility problems. As a result, fertility preservation technology has emerged. Fertility preservation involves interventions and procedures aimed at preserving the patients\' chances of having children when their fertility may have been impaired by their medical conditions or the treatments thereof, for example, chemotherapy and/or radiotherapy for cancer. The changes in patients\' fertility can be temporary or permanent damage. Fertility preservation can help people diagnosed with cancer or other non-malignant diseases. More and more fertility preservation methods are being used to preserve the fertility of cancer patients and protect their reproductive organs from gonadotoxicity. Fertility preservation may be appropriate for young patients with early-stage cancers and good prognosis before they undergo treatments (chemotherapy and/or radiotherapy) that can negatively affect their fertility. It is also appropriate for patients with chronic conditions or those who have encountered environmental exposures that affect their gonadal function. Fertility preservation methods include oocyte cryopreservation, embryo cryopreservation, and ovarian tissue cryopreservation (OTC) for women and sperm freezing and testicular tissue freezing for men. The survival rates of children and adolescents diagnosed with malignant tumors have been steadily increasing as a result of advances in cancer treatments. Cryopreservation of oocytes and sperm is recognized as a well-established and successful strategy for fertility preservation in pubertal patients. OTC is the sole option for prepubertal girls. On the other hand, cryopreservation of immature testicular tissue remains the only alternative for prepubertal boys, but the technology is still in the experimental stage. A review showed that the utilization rate of cryopreserved semen ranged from 2.6% to 21.5%. In the case of cryopreserved female reproductive materials, the utilization rate ranged from 3.1% to 8.7% for oocytes, approximately from 9% to 22.4% for embryos, and from 6.9% to 30.3% for ovarian tissue. When patients have needs for fertility treatment, cryopreserved vitrified oocytes are resuscitated and in vitro fertilization-embryo transfer (IVF-ET) was performed to help patients accomplish their reproductive objectives, with the live birth rate (LBR) being 32%. On the other hand, when cryopreserved embryos are resuscitated and transferred, the LBR was 41%. OTC has the advantage of restoring natural fertility and presents a LBR of 33%, compared with the LBR of 19% among 266 IVF patients. In addition, OTC has the benefit of restoring the endocrine function. It has been observed that the shortest recovery time of the first menstruation after transplantation was 3.9 months, and the recovery rate of ovarian function reached 100%. To date, a growing number of cancer survivors and patients with other diseases are benefiting from fertility preservation measures. In the face of declining human fertility, fertility preservation provides a new approach to human reproduction. Fertility preservation should be applied in line with the ethical principles so as to fully protect the rights and interests of patients and their offsprings.
摘要：
全球育龄人口生育率呈下降趋势，人类面临生育问题的巨大挑战。因此,生育力保存技术应运而生。生育力保护包括干预措施和程序，目的是在患者的生育力可能因其医疗状况或治疗而受损时，保护其生育机会。例如,癌症的化疗和/或放疗。患者生育能力的变化可能是暂时或永久的损害。生育力保护可以帮助被诊断患有癌症或其他非恶性疾病的人。越来越多的生育力保存方法被用于保存癌症患者的生育力，保护其生殖器官免受性腺毒性。保留生育力可能适用于患有早期癌症和预后良好的年轻患者，然后再接受可能对其生育力产生负面影响的治疗（化学疗法和/或放射疗法）。它也适用于患有慢性病的患者或遇到影响其性腺功能的环境暴露的患者。生育力保存方法包括卵母细胞冷冻保存，胚胎冷冻保存,女性卵巢组织冷冻（OTC），男性精子冷冻和睾丸组织冷冻。由于癌症治疗的进展，被诊断患有恶性肿瘤的儿童和青少年的存活率一直在稳步增加。卵母细胞和精子的冷冻保存被认为是青春期患者生育能力保存的一种成熟且成功的策略。OTC是青春期前女孩的唯一选择。另一方面,未成熟睾丸组织的冷冻保存仍然是青春期前男孩的唯一选择，但是这项技术仍处于实验阶段。一项综述显示，冷冻保存精液的利用率为2.6％至21.5％。在冷冻保存的女性生殖材料的情况下，卵母细胞的利用率从3.1%到8.7%不等，胚胎大约从9%到22.4%，卵巢组织从6.9%到30.3%。当患者需要生育治疗时，冷冻保存的玻璃化卵母细胞复苏，并进行体外受精-胚胎移植（IVF-ET）以帮助患者实现其生殖目标，活产率（LBR）为32％。另一方面,当冷冻保存的胚胎复苏和转移时，LBR为41%。OTC具有恢复自然肥力的优势，LBR为33%，在266例IVF患者中，LBR为19%。此外,OTC具有恢复内分泌功能的益处。据观察，移植后第一次月经的最短恢复时间为3.9个月，卵巢功能恢复率达100%。迄今为止,越来越多的癌症幸存者和患有其他疾病的患者正在受益于保留生育能力的措施。面对人类生育率的下降，生育力保存为人类生殖提供了新的途径。生育保护应符合伦理原则，以充分保护患者及其后代的权益。
