Fertilitenin Korunması

Fertilitenin korunması; Kemoterapi, radyoterapi, cerrahi gibi tıbbi müdahaleler, nononkolojik diğer nedenlerden dolayı, fer- tilitenin devamlılığını sağlayabilmek için, gonad hücreleri (oosit ya da sperm), dokularının (Over, Testis) gonadotoksisite maru- ziyetinden korunmasıdır. Güncel olarak fertilitenin korunması için en sık kullanılan metotlar; embriyo kriyoprezervasyonu, sperm ve oosit kriyoprezervasyonu, radyoterapi öncesi overin transpozisyonudur. Yumurtalık dokusu dondurma, GnRH ana- log kullanımı, Testiküler doku kriyoprezervasyonu ve izole Sper- matogonyal kök hücre transplantasyonu, xenotransplantasyon ve invitro sperm matürasyonu üzerinde çalışmaların devam etti- ği diğer metotlardır. Fertilite Koruyucu yaklaşımlarla ilgili has- taların yeterli düzeyde yönlendirilmesi, hasta ve hekimlerinin, toplumun konu hakkında bilgi ve farkındalığının arttırılması, önemi giderek artan güncel bir sorun olarak karşımıza çıkmak- tadır.

Fertility Preservation

Gonad cells (oocyte or spermatozoon) and tissues (ovary, testicle) are protected from gonadotoxic exposure to ensure the continu- ity of fertility due to medical interventions such as chemotherapy, radiotherapy, surgery, and the other non-oncological reasons. De- pending on the progress of the cancer treatment, an increasing rate of patient survival has led to an increased importance of the fertil- ity preservation concept. The currently used methods for fertility preservation are cryopreservation of the embryo, cryopreservation of the sperm and oocytes, ovarian transposition before radiother- apy, ovarian tissue freezing, GnRH analogue use, testicular tissue cryopreservation, and isolated spermatogonial stem cell transplan- tation, xenotransplantation, and some other methods of ongoing sperm maturation. Fertility patients and physicians are increas- ingly aware of the importance of protecting patients, increasing the knowledge and awareness of the society about the subject, and that this is an increasing contemporary problem.

Kaynakça

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Picton HM, Wyns C, Anderson RA, Goossens E, Jahnukainen K, Kliesch S, et al; ESHRE Task force on fertility preservation in severe diseases. A European perspective on testicular tissue cryopreservation for fertility preservation in prepubertal and adolescent boys. Hum Reprod 2015; 30: 2463-75. [CrossRef ]

Waimey KE, Duncan FE, Su HI, Smith K, Wallach H, Jona K, et al. Future directions in oncofertility and fertility preservation: A Report from the 2011 Oncofertility Consortium Conference. J Adolesc Young Adult Oncol 2013; 2: 25-30. [CrossRef ]

Bedoschi G, Oktay K. Current approach to fertility preserva- tion by embryo cryopreservation. Fertil Steril 2013; 99: 1496- 502. [CrossRef ]

Gidoni Y, Holzer H, Tulandi T, Tan SL. Fertility preservation in patients with non-oncological conditions. Reprod Biomed Online 2008; 16: 792-800. [CrossRef ]

Boots CE, Meister M, Cooper AR, Hardi A, Jungheim ES. Ovarian stimulation in the luteal phase: systematic review and meta-analysis. J Assist Reprod Genet 2016; 33: 971-80. [CrossRef ]

Pfeifer S, Goldberg J, Lobo R, Thomas M, Pisarska M, Widra E, et al. Practice Committee of American Society for Repro- ductive Medicine. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril 2013; 100: 1214-23. [CrossRef ]

Pfeifer S, Goldberg J, McClure R, Lobo R, Thomas M, Widra E, et al. Practice Committees of American Society for Repro- ductive Medicine. Society for Assisted Reproductive Techno- logy. Mature oocyte cryopreservation: a guideline. Fertil Steril 2013; 99: 37-43. [CrossRef ]

Cil AP, Bang H, Oktay K. Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta- analysis. Fertil Steril 2013; 100: 492-9. [CrossRef ]

Dittrich R, Hackl J, Lotz L, Hoffmann I, Beckmann MW. Pregnancies and live births after 20 transplantations of cryopre- served ovarian tissue in a single center. Fertil Steril 2015; 103: 462-8. [CrossRef ]

Meirow D, Roness H, Kristensen SG, Andersen CY. Optimi- zing outcomes from ovarian tissue cryopreservation and trans- plantation; activation versus preservation. Hum Reprod 2015; 30: 2453-6. [CrossRef ]

Donnez J, Dolmans MM, Demylle D, Jadoul P, Pirard C, Squ- ifflet J, et al. Livebirth after orthotopic transplantation of cryop- reserved ovarian tissue. Lancet 2004; 364: 1405-10. [CrossRef ]

Donnez J, Dolmans MM, Pellicer A, Diaz-Garcia C, Sanchez Serrano M, Schmidt KT, et al. Restoration of ovarian activity and pregnancy after VOL. 103 NO. 2 / FEBRUARY 2015 467 Fertility and Sterility® transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril 2013; 99: 1503-13. [CrossRef ]

Donnez J, Dolmans MM. Preservation of fertility in females with haematological malignancy. Br J Haematol 2011; 154: 175-84. [CrossRef ]

Gracia CR, Sammel MD, Freeman E, Prewitt M, Carlson C, Ray A, et al. Impact of cancer therapies on ovarian reserve. Fer- til Steril 2012; 97: 134-40. [CrossRef ]

Gubbala K, Laios A, Gallos I, Pathiraja P, Haldar K, Ind T. Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis. J Ovarian Res 2014; 7: 69. [CrossRef ]

Mossa B, Schimberni M, Di Benedetto L, Mossa S. Ovarian transposition in young women and fertility sparing. Eur Rev Med Pharmacol Sci 2015; 19: 3418-25.

Turner NH, Partridge A, Sanna G, Di Leo A, Biganzoli L. Uti- lity of gonadotropin-releasing hormone agonists for fertility preservation in young breast cancer patients: the benefit rema- ins uncertain. Ann Oncol 2013; 24: 2224-35. [CrossRef ]

Gerber B, Ortmann O. Prevention of Early Menopause Study (POEMS): is it possible to preserve ovarian function by gona- dotropin releasing hormone analogs (GnRH)? Arch Gynecol Obstet 2014; 290: 1051-3.

Del Mastro L, Boni L, Michelotti A, Gamucci T, Olmeo N, Gori S, et al. Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-indu- ced early menopause in premenopausal women with breast can- cer: a randomized trial. JAMA 2011; 306: 269-76. [CrossRef ]

Bildik G, Akin N, Senbabaoglu F, Sahin GN, Karahuseyinoglu S, Ince U, et al. GnRH agonist leuprolide acetate does not con- fer any protection against ovarian damage induced by chemot- herapy and radiation in vitro. Hum Reprod 2015; 30: 2912-25.

Kaynak Göster

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