目的:描述一名镰状细胞病患者,血栓前疾病,在造血干细胞移植之前,为了保存生育能力而进行了成功的胚胎冷冻保存。
方法:报告一例成功的促性腺激素刺激和胚胎冷冻保存的案例,使用芳香化酶抑制剂来曲唑维持低血清雌二醇,以降低镰状细胞病(SCD)和视网膜动脉血栓形成史计划造血干细胞移植(HSCT)患者的血栓形成风险。在HSCT之前,患者接受来曲唑(每天5mg)以及预防性依诺肝素,同时使用拮抗剂方案进行促性腺激素刺激以保持生育能力。取卵后,来曲唑再继续治疗一周.
结果:患者在促性腺激素刺激期间的血清雌二醇峰值浓度为172pg/mL。回收10个成熟卵母细胞,冷冻保存总共10个胚泡。由于疼痛,患者在取卵后需要止痛药和静脉输液,但在预定的术后第一天随访中有显着改善。在刺激期间或其后6个月未发生栓塞事件。
结论:干细胞移植治疗SCD的应用正在增加。我们成功地使用来曲唑在促性腺激素刺激期间与预防性依诺肝素一起维持低血清雌二醇,以减少血栓形成的风险。这种方法将使计划通过干细胞移植进行明确治疗的患者有机会安全地保持其生育能力。
OBJECTIVE: To describe a patient with sickle cell disease, a prothrombotic disorder, who underwent successful embryo cryopreservation for the purposes of fertility preservation prior to hematopoietic stem cell transplant.
METHODS: To report a successful
case of gonadotropin stimulation and embryo cryopreservation using the aromatase inhibitor letrozole to maintain low serum estradiol to minimize thrombotic risk in a patient with sickle cell disease (SCD) and history of retinal artery thrombosis planning hematopoietic stem cell transplant (HSCT). The patient was given letrozole (5 mg daily) as well as prophylactic enoxaparin while undergoing gonadotropin stimulation with an antagonist protocol to preserve fertility prior to HSCT. After the oocyte retrieval, letrozole was continued for one additional week.
RESULTS: The patient\'s peak serum estradiol concentration was 172 pg/mL during gonadotropin stimulation. Ten mature oocytes were retrieved and a total of 10 blastocysts were cryopreserved. The patient required pain medication and intravenous fluids after oocyte retrieval due to pain but had significant improvement at the scheduled post-operative day one follow-up. No embolic events occurred during stimulation or 6 months thereafter.
CONCLUSIONS: The utilization of definitive treatment for SCD with stem cell transplant is increasing. We successfully used letrozole to maintain low serum estradiol during gonadotropin stimulation along with prophylactic enoxaparin in a patient with SCD to minimize her risk of thrombosis. This approach will allow patients planning definitive treatment with stem cell transplant the opportunity to preserve their fertility safely.