The options for preserving reproductive functions in women undergoing cytostatic therapy
Authors:
P. Němec 1; M. Huser 2; M. Souček 1
Authors‘ workplace:
Revmatologická ambulance II. interní kliniky Lékařské fakulty MU a FNB u sv. Anny Brno, přednosta doc. MUDr. Miroslav Souček, CSc.
1; Centrum asistované reprodukce CAR 01 Gynekologicko-porodnické kliniky Lékařské fakulty MU a FN Brno, pracoviště reprodukční medicíny, přednosta prof. MUDr. Pavel Ventruba, DrSc.
2
Published in:
Vnitř Lék 2008; 54(3): 245-250
Category:
Review
Overview
The therapy of serious organ damages in systemic connective tissue diseases and systemic vasculitis often requires the use of cytostatics. The serious adverse events associated with such therapy include irreversible damage to the foetal gonadal tissue. Unlike in the case of other fast proliferating tissues of the human body, damage to the ovaries is mostly irreversible, due to the predetermined number of ovarian follicles at birth. Destruction of follicles causes primary ovarian insufficiency and the subsequent sterility with climacteric syndrome symptoms. The issue of preserving ovarian function has not yet been fully resolved. The paper provides an overview of current options for the preservation of reproductive functions in women undergoing cytostatic therapy which include modern techniques of assisted reproduction and new methods of pharmacological protection of the ovaries using gonadoliberin analogues.
Key words:
assisted reproduction – GnRH analogues – sterility – systemic connective tissue disease
Sources
1. Lukác J, Rovenský J, Lukácová O et al. Systemic lupus erythematodes. Vnitř Lék 2006; 52: 702-711.
2. Laml T, Schulz-Lobmeyr I, Obruca A et al. Prematureovarian failure: etiology and prospects. Gynecol Endocrinol 2000; 14: 292-302.
3. Ataya K, Rao LV, Laurence E et al. Luteinizing hormone-releasing hormone agonist inhibits cyclophosphamide induced ovarian follicular depletion in Rhesus monkeys. Biol Reprod 1995; 52: 365-372.
4. Blumenfeld Z. How to preserve fertility in young women exposed to chemotherapy? The role of GnRH agonist cotreatment in addition to cryopreservation of embrya, oocytes, or ovaries. Oncologist 2007; 12: 1044-1054.
5. Blumenfeld Z, Eckman A. Preservation of fertility and ovarian function and minimization of chemotherapy-induced gonadotoxicity in young women by GnRH-a. J Natl Cancer Inst Monogr 2005; 34: 40-43.
6. Blumenfeld Z, Shapiro D, Shteinberg M et al. Preservation of fertility and ovarian function and minimizing gonadotoxicity in young women with systemic lupus erythematosus treated by chemotherapy. Lupus 2000; 9: 401-405.
7. Crha I, Ventruba P, Žáková J et al. Kryokonzervace spermatu před gonadotoxickou léčbou - 11 let zkušeností. Čes Gynek 2007; 72: 320-326.
8. Boldt J et al. Human oocyte cryopreservation as an adjunct to IVF-embryo transfer cycles. Hum reprod 2003; 18: 1250-1255.
9. Quintans CJ, Donaldson MJ, Bartolino MV et al. Birth of two babies oocytes that were cryopreserved in a choline-based freezing medium. Hum Reprod 2002; 17: 3149-3152.
10. Marrs RP, Greene J, Stone BA. Potential factors affecting embryo survival and clinical outcome with cryopreserved pronuclear human embryos. Am J Obstet Gynecol 2004; 190: 1766-1771.
11. D’Angelo A, Amso NN. Embryo freezing for preventing ovarian hyperstimulation syndrome: a Cochrane review. Hum Reprod 2002; 17: 2787-2794.
12. Meirow D, Fasouliotis SJ, Nugent D et al. A laparoscopic technique for obtaining ovarian cortical biopsy specimens for fertility conservation in patients with cancer. Fertil Steril 1999; 71: 948-951.
13. Donnez J, Bassil S. Indications for cryopreservation of ovarian tissue. Hum Reprod Update 1998; 4: 248-259.
14. Oktay K. Ovarian tissue cryopreservation and transplantation: preliminary findings and implications for cancer patients. Hum Reprod Update 2001; 7: 526-534.
15. Rutherford AJ, Gosden RG. Ovarian tissue cryopreservation: a practical option? Acta Paediatr 1999; 88: 13-18.
16. Hovatta O. Methods for cryopreservation of human ovarian tissue. Reprod Biomed Online 2005; 10: 729-734.
17. Newton H, Aubard Y, Rutherford A et al. Low temperature storage and grafting of human ovarian tissue. Hum Reprod 1996; 11: 1487-1491.
18. Newton H, Fisher J, Arnold JR et al. Permeation of human ovarian tissue with cryoprotective agents in preparation for cryopreservation. Hum Reprod 1998; 13: 376-380.
19. Gook DA, Edgar DH, Borg J et al. Oocyte maturation, follicle rupture and luteinization in human cryopreserved ovarian tissue following xenografting. Hum Reprod 2003; 18: 1772-1781.
20. Candy CJ, Wood MJ, Whittingham DG. Restoration of a normal reproductive lifespan after grafting of cryopreserved mouse ovaries. Hum Reprod 2000; 15: 1300-1304.
21. Almodin CG, Minguetti-Camara VC, Meister H et al. Recovery of fertility after grafting of cryopreserved germinative tissue in female rabbits following radiotherapy. Hum Reprod 2004; 19: 1287-1293.
22. Candy CJ, Wood MJ, Whittingham DG. Follicular development in cryopreserved marmoset ovarian tissue after transplantation. Hum Reprod 1995; 10: 2334-2338.
23. Kim SS, Yang HW, Kang HG et al. Quantitative assessment of ischemic tissue damage in ovarian cortical tissue with or without antioxidant (ascorbic acid) treatment. Fertil Steril 2004; 82: 679-685.
24. Oktay K, Buyuk E, Veeck L et al. Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet 2004; 363: 837-840.
25. Oktay K, Tilly J. Livebirth after cryopreserved ovarian tissue autotransplantation. Lancet 2004; 364: 2091-2092.
26. Bedaiwy MA, Falcone T. Ovarian tissue banking for cancer patients: reduction of post-transplantation ischaemic injury: intact ovary freezing and transplantation. Hum Reprod 2004; 19: 1242-1244.
27. Blumenfeld Z. Preservation of fertility and ovarian function and minimalization of chemotherapy associated gonadotoxicity and premature ovarian failure: the role of inhibin-A and -B as markers. Mol Cell Endocrinol 2002; 187: 93-105.
28. Practice Committee of the American Society for Reproductive Medicine. Ovarian tissue and oocyte cryopreservation. Fertil Steril 2004; 82: 993-998.
29. Martinez-Madrid B, Dolmans MM, Van Langendockt A et al. Freeze-thawing intact human ovary with its vascular pedicle with a passive cooling device. Fertil Steril 2004; 82: 1390-1394.
30. Schilsky R, Sherins R, Hubbard S et al. Long-term follow-up of ovarian function in women treated with MOPP chemotherapy for Hodgkin’s disease. Am J Med 1981; 71: 552-556.
31. Blumenfeld Z. Preservation of fertility and ovarian function and minimalization of chemotherapy associated gonadotoxicity and premature ovarian failure: the role of inhibin-A and -B as markers. Mol Cell Endocrinol 2002; 187: 93-105.
32. Blumendfeld Z. Fertility after treatment for Hodgkin’s disease. Ann Oncol 2002; 13 (Suppl 1): 138-147.
33. Pritchard KI GnRH analogues and ovarian ablation: their integration in the adjuvant strategy. Recent Results Cancer Res 1998; 152: 285-297.
34. Manger K, Wildt L, Kalden JR et al. Prevention of gonadal toxicity and preservation of gonadal function and fertility in young women with systemic lupus erythematosus treated by cyclophosphamide: the PREGO-Study. Autoimmun Rev 2006; 5: 269-272.
35. Mardešić T, Šnajderová M et al. Protocol combining GnRH agonists and GnRH antagonists for rapid supression and prevention of gonadal damage during cytotoxic therapy. Eur J Gynaecol Oncol 2004; 25: 90-92.
36. Huser M, Crha I, Hudecek R et al. Ovarian tissue cryopreservation - new opportunity to preserve fertility in female cancer patients. Eur J Gynaecol Oncol 2007; 28: 249-255.
37. Huser M, Višňová H, Ventruba P et al. Možnosti ochrany reprodukčních funkcí u žen podstupujících chemoterapii pro hematologickou malignitu. Prakt Gyn 2006; 9: 6-8.
38. Huser M, Juránková E, Crha I et al. Kryokonzervace ovariální tkáně - šance na záchranu fertility žen s nádorovým onemocněním. Čes Gynek 2007; 72: 68-73.
39. Paynter SJ. Current status of the cryopreservation of human unfertilized oocytes. Human Reprod Update 2000; 6: 449-456.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
![Issue 3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/a5fbc78c260ffbb3935f50411a81e99a.jpeg)
2008 Issue 3
Most read in this issue
- Idiopathic retroperitoneal fibrosis - Ormond’s disease
- Von Willebrand disease
- SIADH as only paraneoplastic cause of the small cell lung cancer: case report
- Treatment of IgA nephropathy