青春期前和围青春期控制性卵巢刺激和卵母细胞提取的安全性和有效性

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-09-19 DOI:10.1007/s10815-024-03262-y
Sönmezer Meltem, Gemici Ali, Şükür Yavuz Emre, Turan Hande, Alimogulları Ebru, Avşar Betül, Atabekoğlu Cem Somer, Özmen Batuhan, Turan Volkan, Sönmezer Murat
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引用次数: 0

摘要

目的 对青春期前和青春期围绝经期患者进行控制性卵巢刺激(COS)和卵母细胞提取(OR)是否安全有效?COS 后,所有手术均使用阴道超声探头经腹进行。所有受试者的卵巢储备情况均通过血清 FSH、LH、雌二醇、AMH 和前区卵泡计数(AFC)进行评估。结果 患者平均年龄(15.05 ± 1.87)岁,平均 AMH(0.84 ± 0.8 ng/ml),平均 FSH(6.39 ± 3.95 IU/L),平均雌二醇(61.6 ± 51.9 pg/ml),平均 LH(4.69 ± 3.46 IU/L),平均 AFC(5.5 ± 5.82)。其中,12 名患者月经周期规律,5 名患者月经周期不规律,3 名患者月经初潮尚未来潮。OC 的适应症如下:原发性卵巢功能不全(7 例)、卵巢肿瘤(5 例)或卵巢扭转(1 例)、特纳综合征(2 例)、急性淋巴细胞白血病(1 例)、无性 B 细胞淋巴瘤(1 例)、尤文肉瘤(1 例)、努南综合征(1 例)和地中海贫血(1 例)。平均取卵数、冷冻 MII 卵母细胞数和成熟率分别为 5.11 ± 5.0、3.92 ± 4.48 和 75.1 ± 25.6%。逐步线性回归分析表明,AFC 与取回的总卵母细胞数和 MII 卵母细胞数呈正相关。在确诊为努南综合征的病例中,取回的 7 个卵母细胞均为 MI,且均在 MI 期进行了冷冻。结论尽管我们的受试者人数有限,平均 AMH 也较低,但我们证明了在青春期前/青春期后的患者中进行 COS 和 OR 是安全的。如有必要,可在这一年龄组进行经腹径路手术。AFC似乎是这一年龄组刺激结果的预后因素。对于有原发性卵巢功能不全风险的儿童患者或青少年,不应阻止他们使用促排卵药物。
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Safety and effectiveness of controlled ovarian stimulation and oocyte retrieval during prepubertal and peripubertal period

Purpose

Is it safe and effective to perform controlled ovarian stimulation (COS) and oocyte retrieval (OR) in prepubertal and peripubertal patients?

Methods

In this retrospective cohort study, data of 20 pre-/peripubertal patients who underwent COS and OR for the purpose of oocyte cryopreservation (OC) between 2008 and 2023 were reviewed. Following COS, all OR procedures were performed transabdominally using a vaginal ultrasound probe. Ovarian reserve was assessed by serum FSH, LH, estradiol, AMH, and antral follicle counts (AFC) in all subjects. All mature oocytes were vitrified.

Results

Mean age of the patients was 15.05 ± 1.87, mean AMH was 0.84 ± 0.8 ng/ml, mean FSH was 6.39 ± 3.95 IU/L, mean estradiol was 61.6 ± 51.9 pg/ml, mean LH was 4.69 ± 3.46 IU/L, and mean AFC was 5.5 ± 5.82. Among the patients, 12 had regular menstrual cycle, 5 had irregular menstrual cycle, whereas 3 patients still did not have their menarche yet. The indications for OC were as follows: primary ovarian insufficiency (n = 7), ovarian surgery for ovarian tumors (n = 5) or ovarian torsion (n = 1), mosaic Turner syndrome (n = 2), acute lymphoblastic leukemia (n = 1) anaplastic B-cell lymphoma (n = 1), Ewing’s sarcoma (n = 1), Noonan syndrome (n = 1), and Thalassemia (n = 1). The mean number of oocytes retrieved, MII oocytes frozen, and maturation rate were 5.11 ± 5.0, 3.92 ± 4.48, and 75.1 ± 25.6%, respectively. Stepwise linear regression analysis demonstrated a positive correlation between AFC and number of total oocytes retrieved and number of MII oocytes. In the case diagnosed with Noonan syndrome, all 7 retrieved oocytes were MI and all frozen at MI phase. No patient had any complication related to COS or OR.

Conclusion

Even though number of the enrolled subjects is limited and mean AMH is lower in our cohort, we demonstrated that performing COS and OR is safe in pre-/peripubertal patients. If required, transabdominal route can be performed in this age group for OR. AFC appears as a prognostic factor for stimulation outcome in this age group. Pediatric patients or young adolescents at risk for primary ovarian insufficiency should not be discouraged from utilizing OC.

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