Zusammenfassung
Wird bei malignomerkrankten Frauen in der reproduktiven Lebensphase eine Chemo- oder Strahlentherapie erforderlich, so hat dies in vielen Fällen die Infertilität der Patientin zur Folge. Während für den Mann die Kryokonservierung von Ejakulat ein anerkanntes Verfahren zur Fertilitätserhaltung darstellt, ist die Kryokonservierung von Eizellen nicht etabliert. Die Kryokonservierung von reifen Eizellen scheitert an der Empfindlichkeit dieser Zellen gegenüber dem Konservierungsvorgang. Die Kryokonservierung von unreifen und damit robusteren Eizellen ist zwar möglich, die anschließend notwendige In-vitro-Maturation (Reifung) der Zellen ist jedoch nur selten erfolgreich. Seit im letzten Jahr eine belgische Arbeitsgruppe über die erste erfolgreiche Schwangerschaft bzw. Geburt nach Kryokonservierung von ovariellem Gewebe mit anschließender autologer Transplantation berichtet hat, ist die Problematik des Kinderwunschs junger Patientinnen nach einer entsprechenden onkologischen Behandlung in den Fokus des öffentlichen Interesses gerückt [[1 ], [2 ]]. Dadurch, dass die Entwicklung dieser Strategien erst in den „Kinderschuhen“ steckt, sollten sie lediglich an ausgewiesenen Zentren, nach ausführlicher interdisziplinärer Beratung der betroffenen Patientin über die geringen Erfahrungen beim Menschen, durchgeführt werden. In der Hand des verantwortungsbewussten Experten und im Einvernehmen mit der Patientin werden diese Techniken jedoch mit wachsender Erfahrung in Zukunft im Rahmen einer interdisziplinären und individuellen onkologischen Behandlung bzw. Betreuung zunehmend an Bedeutung gewinnen.
Abstract
Recent advances in the diagnosis and treatment of childhood, adolescent, and adult cancer have greatly enhanced the life expectancy of men and women with cancer. However, for most men and women, gonadal damage caused by radio- and/or chemotherapy will result in irreversible infertility. In contrast to the well established strategy of sperm cryopreservation in men, the technique of oocyte cryopreservation is still experimental. Since Donnez et al. published an account in 2004 about the first successful pregnancy after cryopreservation and autologous transplantation of ovarian tissue, the problem of fertility prophylaxis in female cancer patients has attracted broader attention [[2 ]]. With respect to the current limited experience regarding the different strategies, these patients should be counselled extensively in a multidisciplinary approach about the limited available evidence in the human. In the near future, however, with growing expertise in that field this concept will become an integral part of individual treatment in young female cancer patients.
Key words
Malignom - Infertilität - Prophylaxe
Key words
Malignancy - infertility - prophylaxis
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Prof. Dr. G. Gitsch
Universitäts-Frauenklinik Freiburg
Hugstetter Straße 55
79106 Freiburg
Email: gitsch@srk.ukl.uni-freiburg.de