Fertilitätserhalt bei Krebs

Zusammenfassung

Fragestellung: Die Fortschritte der Therapie maligner Erkrankungen und der Reproduktionsmedizin ermöglichen es vielen Patienten, auch nach zytotoxischer Therapie ihre Familienplanung in Angriff zu nehmen. Die Grundhaltung der Betroffenen zu fertilitätserhaltenden Maßnahmen ist deshalb durchweg positiv. Techniken des Fertilitätserhalts: Grundsätzlich wird zwischen medikamentösen und invasiven Maßnahmen zur Fertilitätsprotektion unterschieden. Die weitverbreitete Therapie mit GnRH-Analoga ist einfach und ohne Zeitverzug umzusetzen und wird deshalb breit klinisch genutzt, auch wenn ihr Nutzen nicht endgültig geklärt ist. Klassische Maßnahmen der assistierten Reproduktion sind an eine stabile Partnerschaft gebunden, weshalb zunehmend die Technik der Kryokonservierung unfertilisierter Oozyten nach hormoneller Stimulation eingesetzt wird. Die zunehmend besseren Kryokonservierungsprotokolle machen diese Technik attraktiv. Ein Hauptproblem der assistierten Reproduktion ist die zyklusabhängige hormonelle Stimulation. Neue Stimulationsprotokolle, die zu jedem Zeitpunkt des Zyklus einen Beginn ermöglichen, sind derzeit in Studien in Erprobung. Letztlich wird auch die Ovarteilresektion mit Kryokonservierung und späterer Replantation angeboten. Mit dieser Technik sind bereits mehrere Schwangerschaften erzielt worden. Schlussfolgerung: Bei der Fülle von Möglichkeiten zum Fertilitätserhalt muss oft ein multimodales Konzept individuell mit der Patientin besprochen werden. Viele der Methoden sind gut kombinierbar. Um eine flächendeckende Versorgung anbieten zu können und zur Evaluation der fertilitätsprotektiven Methoden, ist ein Netzwerk wie FertiProtekt absolut notwendig.

Abstract

Purpose: Advances in oncological treatment and in reproductive medicine have made family planning and fertility preservation after cytotoxic treatment more and more attractive. The attitude of patients towards fertility preservation is definitely positive. Techniques of Fertility Preservation: Basically, both medical treatments and invasive procedures are possible. Ovarian down-regulation by GnRH analogues is widely used and simple to perform, with little delay. However its efficacy has still not been definitely proven. Standard methods of ART require a stable partnership. Therefore, cryopreservation of unfertilized oocytes after hormonal stimulation might be better for most patients. In recent years, the introduction of new cryopreservation protocols allows acceptable results. Since hormonal stimulation is cycle dependent, it might cause a delay in oncologic treatment. New stimulation protocols, which can be initiated in every cycle phase are under investigation. Finally, ovarian biopsy and cryopreservation, followed by replantation might be an option. The first pregnancies and deliveries have been described. Conclusion: In most cases a multimodal approach must be offered to the patient. Most treatment modalities can be combined. To offer comprehensive treatment and allow the current techniques of fertility preservation to be evaluated, patients and doctors would benefit from networks such as like FertiProtekt, which guarantees nationwide patient support.

Schlüsselwörter

Fertilitätsprotektion - GnRH‐Analoga - Ovarreplantation - Kryokonservierung

Key words

fertility preservation - GnRh analogues - ovarian replantation - cryopreservation

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