Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases

Journal of Ovarian Research

Research

Tomoko Ishimaru¹  Hiroki Utsuno¹  Miho Matsumoto¹  Rika Yano²  Kazuko Takahashi²  Akiko Ebara²  Hiroe Sakanaka²  Mitsutoshi Yamada³  Reina Ooka³  Kazuhiro Akashi³  Shintaro Kamijo³  Toshio Hamatani³  Mio Fukuoka³  Saki Saito³  Mamoru Tanaka³  Yuichi Matsuzawa³ 

[1] Clinical Laboratory, Keio University Hospital, 35 Shinanomachi, 160-8582, Shinjuku-Ku, Tokyo, Japan;Department of Nursing, Keio University Hospital, 35 Shinanomachi, 160-8582, Shinjuku-Ku, Tokyo, Japan;Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku-Ku, Tokyo, Japan;

关键词: Cancer;    Autoimmune disease;    Fertility preservation;    Gonadotropin-releasing hormone analogue;    Progestin-primed ovarian stimulation;    Female infertility;    Cryopreservation;    Oocyte quality;    Embryo quality;    Remission;   

DOI  :  10.1186/s13048-023-01250-x

 received in 2023-03-07, accepted in 2023-07-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe indications for fertility preservation (FP) have expanded. A few patients who underwent gonadotoxic treatment did not have the opportunity to receive FP, leading to concerns that these patients may develop premature ovarian insufficiency. However, the usefulness of FP in women with reduced ovarian reserve has also been questioned. Progestin-primed ovarian stimulation can improve the controlled ovarian stimulation (COS) protocol, but there is limited data on the efficacy of FP with progestin-primed ovarian stimulation.MethodsWe conducted a prospective study of 43 women with cancer or autoimmune diseases before and after gonadotoxic treatment at the reproductive unit of Keio University Hospital, counselled between 1 January 2018 and 31 December 2021. After counselling, informed consent was obtained for FP from 43 patients, with those who underwent gonadotoxic treatment of the primary disease being prioritised. Gonadotropin-releasing hormone analogue or progestin was used to suppress luteinising hormone in COS before or after gonadotoxic treatment. The number of cryopreserved mature oocytes was the primary outcome.ResultsForty-three patients and 67 assisted reproductive technology cycles were included in the analysis. The median age at entry was 32 [inter quartile range (IQR), 29–37] years. All patients in the post-gonadotoxic treatment group had their oocytes frozen. Gonadotoxic treatment resulted in fewer oocytes [median 3 (IQR 1–4); pre-gonadotoxic treatment group: five patients, 13 cycles] vs. median 9 (IQR 5–14; pre-gonadotoxic treatment group: 38 patients, 54 cycles; P < 0.001). Although anti-Müllerian hormone levels were lower in the post-gonadotoxic treatment group (n = 5, 13 cycles, median 0.29 (IQR 0.15–1.04) pg/mL) than in the pre-gonadotoxic treatment group (n = 38, 54 cycles, median 1.89 (IQR 1.15–4.08) pg/mL) (P = 0.004), oocyte maturation rates were higher in the post-gonadotoxic treatment group [median 100 (IQR 77.5–100) %] than in the pre-gonadotoxic group [median 90.3 (IQR 75.0–100) %; P = 0.039]. Five patients in the pre-gonadotoxic treatment group had their cryopreserved embryos thawed, of which three had live births.ConclusionsOocytes obtained for FP from women with cancer or autoimmune disease for FP are of satisfactory quality, regardless of whether they are obtained post-gonadotoxic treatment or COS protocols.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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