Reproduktionsmedizin. Optimierte Transportbedingungen für konserviertes Ovarialgewebe

Die Überlebensraten von Krebspatientinnen haben sich mittels moderner Behandlungsmethoden in den letzten Jahren merklich erhöht. Allerdings führen die Therapien sehr häufig zu einer Sterilität und viele Frauen müssen sich nach erfolgreicher Therapie mit dem Verlust ihrer Fruchtbarkeit auseinandersetzen. Dies lässt Fragen nach Möglichkeiten zum Erhalt oder Wiederherstellung der Fertilität dieser Patientinnen aufkommen. Neben der Transposition der Gonaden vor einer Radiotherapie, dem medikamentösen Gonadenschutz durch GnRH-Analoga und der Kryokonservierung von befruchteten und unbefruchteten Eizellen hat sich vor allem die Kryokonservierung von Ovarialgewebe als Methode der Fertilitätsprotektion etabliert, über die wir im Folgenden berichten möchten.

• Literatur

• 1 Maltaris T, Seufert R, Fischl F et al. The effect of cancer treatment on female fertility and strategies for preserving fertility. Eur J Obstet Gynecol Reprod Biol 2007; 130: 148-155
• 2 Dittrich R, Maltaris T, Hoffmann I et al. Fertility preservation in cancer patients. Minerva ginecologica 2010; 62: 63-80
• 3 Wo JY, Viswanathan AN. Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys 2009; 73: 1304-1312
• 4 Chhabra S, Kutchi I. Fertility preservation in gynecological cancers. Clin Med Insights Reprod Health 2013; 7: 49-59
• 5 McCall ML, Keaty EC, Thompson JD. Conservation of ovarian tissue in the treatment of carcinoma of the cervix with radical surgery. Am J Obstet Gynecol 1958; 75: 590-600 discussion 600–605
• 6 Thomas PR, Winstanly D, Peckham MJ et al. Reproductive and endocrine function in patients with Hodgkinʼs disease: effects of oophoropexy and irradiation. Br J Cancer 1976; 33: 226-231
• 7 Bisharah M, Tulandi T. Laparoscopic preservation of ovarian function: an underused procedure. Am J Obstet Gynecol 2003; 188: 367-370
• 8 Wang C, Chen M, Fu F et al. Gonadotropin-releasing hormone analog cotreatment for the preservation of ovarian function during gonadotoxic chemotherapy for breast cancer: a meta-analysis. PloS one 2013; 8: e66360
• 9 Bedaiwy MA, Abou-Setta AM, Desai N et al. Gonadotropin-releasing hormone analog cotreatment for preservation of ovarian function during gonadotoxic chemotherapy: a systematic review and meta-analysis. Fertil Steril 2011; 95: 906-914.e1–4
• 10 Dittrich R, Lotz L, Mueller A et al. Oncofertility: combination of ovarian stimulation with subsequent ovarian tissue extraction on the day of oocyte retrieval. Reprod Biol Endocrinol 2013; 11: 19
• 11 Leinmüller R. Malignome in der Kindheit: Eizellen bei fünfjährigen Mädchen punktiert. Dtsch Arztebl International 2007; 104: A-2556
• 12 Chung K, Donnez J, Ginsburg E et al. Emergency IVF versus ovarian tissue cryopreservation: decision making in fertility preservation for female cancer patients. Fertil Steril 2013; 99: 1534-1542
• 13 Lawrenz B, Jauckus J, Kupka MS et al. Fertility preservation in > 1,000 patients: patientʼs characteristics, spectrum, efficacy and risks of applied preservation techniques. Arch Gynecol Obstet 2011; 283: 651-656
• 14 Donnez J, Dolmans MM, Pellicer A et al. Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril 2013; 99: 1503-1513
• 15 Amorim CA, Curaba M, Van Langendonckt A et al. Vitrification as an alternative means of cryopreserving ovarian tissue. Reprod Biomed Online 2011; 23: 160-186
• 16 Dittrich R, Hackl J, Lotz L et al. Pregnancies and live births after 20 transplantations of cryopreserved ovarian tissue in a single center. Fertil Steril 2015; 103: 462-468
• 17 Donnez J, Dolmans MM. Transplantation of ovarian tissue. Best Pract Res Clin Obstet Gynaecol 2014; 28: 1188-1197
• 18 Schmidt KL, Ernst E, Byskov AG et al. Survival of primordial follicles following prolonged transportation of ovarian tissue prior to cryopreservation. Hum Reprod 2003; 18: 2654-2659
• 19 Rosendahl M, Schmidt KT, Ernst E et al. Cryopreservation of ovarian tissue for a decade in Denmark: a view of the technique. Reprod Biomed Online 2011; 22: 162-171
• 20 Sigot V, Pellegrino JM, Guibert EE et al. A modular perfused chamber for low- and normal-temperature microscopy of living cells. Biotechniques 2011; 50: 251-254
• 21 Isachenko E, Isachenko V, Nawroth F et al. Effect of long-term exposure at suprazero temperatures on activity and viability of human ovarian cortex. Fertil Steril 2009; 91: 1556-1559
• 22 Isachenko V, Isachenko E, Mallmann P et al. Long-time cooling of human ovarian tissue before cryopreservation as obvious procedure: stimulation of follicular development and neo-vascularisation. Clin Lab 2012; 58: 1293-1300
• 23 Isachenko V, Isachenko E, Peters D et al. In vitro perfusion of whole bovine ovaries by freezing medium: effect of perfusion rate and elapsed time after extraction. Clin Lab 2013; 59: 1159-1166
• 24 Yin H, Wang X, Kim SS et al. Transplantation of intact rat gonads using vascular anastomosis: effects of cryopreservation, ischaemia and genotype. Human Reprod 2003; 18: 1165-1172
• 25 Dittrich R, Lotz L, Keck G et al. Live birth after ovarian tissue autotransplantation following overnight transportation before cryopreservation. Fertil Steril 2012; 97: 387-390
• 26 Wood TC, Montali RJ, Wildt DE. Follicle-oocyte atresia and temporal taphonomy in cold-stored domestic cat ovaries. Mol Reprod Dev 1997; 46: 190-200
• 27 Klocke S, Tappehorn C, Griesinger G. Effects of supra-zero storage on human ovarian cortex prior to vitrification-warming. Reprod Biomed Online 2014; 29: 251-258