Armagan Aydin, Hulya Ayik Aydin, A. Yasemin Goksu Erol

Dondurulmuş/Çözülmüş Over Dokusunun Ototransplantasyonu: Yöntem ve Sorunlara Genel Bakış

Amaç Son yıllarda malign veya malign olmayan hastalık teşhisi alan artan sayıda kadın hasta sitotoksik kemoradyoterapiye maruz kalmıştır. Sitotoksik tedavinin neden olduğu erken ovaryanyetmezlik olasılığına maruz kalan kadınlar, ovaryum dokusunun dondurularak korunması yoluyla doğurganlık potansiyellerini koruyabilirler. Avantajlarına rağmen, üreme fonksiyonunukaybetme riski taşıyan kadınlarda bu fertilite koruma yöntemi henüz deneysel kabul edilmektedir. Bunun en önemli iki nedeni; 1) Ovaryan foliküler havuzda bir azalma durumu: Geliştirilmişyöntemler ile en aza indirilmiş olmasına rağmen kriyoprezervasyon ve çözülme prosedürlerinin bir sonucu olarak ve ovaryan transplantasyon esnasında meydana gelen iskemik hasar nedeniile görülmektedir. 2) Minimal rezidüel hastalık riski: Kanser hastaları için ovaryum dokusunda dondurma öncesi var olan kanser hücrelerinin ovaryum transplantasyonu yoluyla tekrarhastaya verilme riski olarak tanımlanabilir. Her ne kadar ovaryan kriyoprezervasyon endikasyonları kanserin ötesine geçse de, kanserden kurtulanlar bu işleme en çok ihtiyaç duyan hastapopülasyonudur. Bu hastalar için minimal rezidüel hastalık riski, bu yöntemin uygulanmasında önemli bir sıkıntıdır. Önceden var olan kanser hücrelerinin yeniden yerleştirilme riski çoğukanser tipinde olmasa ya da minimal olsa da, bu risk kanser tipine ve hastalık evresine göre tespit edilmelidir. Ayrıca, ovaryan doku transplantasyonunun etkinliği, ovaryan foliküler kaybınazaltılmasındaki başarı oranı ile ortaya konabilecektir. Bu amaçla çok sayıda deney, transplante over graftında iskemik hasarı azaltmaya ve insan over dokusunun kriyoprezervasyonunda‘slow freezing’ ve ‘vitrifikasyon’ yöntemlerinin karşılaştırılarak en iyi yöntem/protokolü belirlemeye çalışmaktadır. ( Sakarya Tıp Dergisi 2019, 9(1):1-10 ).

Autotransplantation of Cryopreserved/Thawed Ovarian Tissue: Overview of Methods and Challenges

Objective In recent years, an increasing number of women diagnosed with malignant or non-malignant diseases have been subjected to cytotoxic chemoradiotherapy. Women who face the possibility of premature ovarian failure caused by cytotoxic therapy may retain their fertility potential via ovarian tissue cryopreservation. Despite its advantages, this fertility preservation method for women at risk of losing reproductive function is considered experimental due to 1) a possible decrease in the ovarian follicular pool as a result of cryopreservation and thawing procedures (although this has been minimised by improved methods), or by ischemic damage occurring in the graft during ovarian transplantation; and 2) the risk of minimal residual disease for cancer patients which can be defined as reintroducing pre-existing cancer cells in ovarian tissue before cryopreservation. Although the indications for ovarian cryopreservation now extend beyond cancer, cancer survivors remain as the patient population who most commonly need this procedure. For these patients, the risk of minimal residual disease is an important challenge for the application of this method. Even though the risk of reimplanting pre-existing cancer cells through ovarian transplantation is minimal or non-existent for most types of cancer, this risk must be ascertained according to cancer type and disease stage. Moreover, the efficacy of ovarian tissue transplantation is determined by the degree of success in minimising follicular loss. For this purpose, many experiments aim to reduce ischemic damage in transplanted ovarian grafts, and to determine the best methods/protocols for human ovarian cryopreservation, comparing ‘slow freezing’ and ‘vitrification’. ( Sakarya Med J 2019, 9(1):1-10 )

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