Fertilitätserhalt bei Patientinnen mit Mammakarzinom – eine aktuelle Übersicht

Zusammenfassung

Bei vielen prämenopausalen Patientinnen, die an einem Mammakarzinom erkranken, ist die Familienplanung noch nicht abgeschlossen, sodass für den Erhalt des fertilen Potenzials Maßnahmen der Fertilitätsprotektion sinnvoll sind. Durch eine Polychemotherapie – unabhängig ob im neoadjuvanten oder adjuvanten Setting – kommt es zu einer irreversiblen Schädigung der Follikel, was unter Umständen zu einer permanenten Infertilität führen kann. Abhängig von den verwendeten Zytostatika und der altersabhängigen Ovarialreserve der Frau, muss das gonadotoxische Risiko als niedrig, mittel oder hoch eingeschätzt werden. Möglichkeiten des Fertilitätserhalts sind: a) die Kryokonservierung von fertilisierten oder unfertilisierten Oozyten. Hierbei werden nach ovarieller Hyperstimulation reife Oozyten mittels transvaginaler Follikelaspiration gewonnen und im Anschluss entweder unfertilisiert oder nach erfolgter IVF- oder ICSI-Behandlung kryokonserviert. Bei b) der Kryokonservierung von Ovarialgewebe wird mithilfe eines laparoskopischen Eingriffs etwa 50% des Ovarkortex eines Ovars reseziert und kryokonserviert. Die Verwendung von c) GnRH-Agonisten als medikamentöse Therapieoption unternimmt den Versuch einer endokrinen Ovarialsuppression, um Oozyten, Granulosa- und Thekazellen vor dem zytotoxischen Einfluss der Chemotherapie zu schützen.

Schlüsselwörter

Mammakarzinom - Fertilitätserhalt - Kryokonservierung - Oozyten - Ovargewebe - GnRH-Agonisten

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