自體移植解凍卵巢組織能暫時恢復排卵功能


  Oct. 16, 2003 --根據一項新的研究指出,自體移植解凍卵巢組織到人體所造成內分泌功能和自發性排卵功能的暫時恢復,對於乳癌婦女保有生育能力是一項可行的對策。
  
  韓國漢城Eulji 大學醫藥院的S. Samuel Kim博士和同事星期三在德州聖安東尼奧所舉辦的美國生殖醫學協會第59屆年度會議上口頭發表他們的研究發現。
  
  根據研究人員指出,早前的報告顯示,新鮮卵巢組織在異位性自體移植後能恢復其排卵功能,但在解凍卵巢組織方面並沒有被證實。
  
  這項研究僅在一位病患上實施過,但是Kim博士在電話訪談中告訴Medscape,他預期這項做法對其他病患有效,此外,雖然報告聲明最初的移植在31個星期後終止其有效性,但是隨後移植解凍組織到同一病患身上,在移植後將持續作用一年。
  
  在他們的報告中,Kim醫生和同事描述一位37歲月經規則且經診斷患有第一期下的子宮頸麟狀細胞癌婦女,這位婦女被排定接受根除性子宮切除、淋巴腺切除和放射療法,在治療前,病患同意接受兩邊輸卵管卵巢切除術以保存她的卵巢組織。
  
  被分成薄皮層切片(1 x 1 x 5 mm)的卵巢,被冷凍和儲存在液態氮中,為了自體移植,被儲存的卵巢組織的40個皮層部分被解凍和分成二組,研究人員移植一組到胸肌與乳房組織間的空間,另一組則移植到直肌鞘與直肌間的空間。
  
  Kim醫生和同事測量血清中的促濾泡激素(FSH),黃體成長激素(LH)、動情素和黃體激素的濃度,在移植後10週,血中荷爾蒙濃度與停經期的狀態一致。
  
  然而,在14星期後,荷爾蒙濃度顯示了卵巢功能的恢復,血清中的動情素為57.5 pg/mL,FSH 是39 IU/L,此外也檢測到一個顯性濾泡(8.5 x 11 mm)。
  
  移植後一開始的24週,荷爾蒙濃度每二天測量一次持續五星期,在這個期間,自發性排卵是指LH激增(69.8 IU/L),隨後黃體激素濃度的增加(9.6 ng/mL),LH激增之前,動情素濃度為305 pg/mL,另外經過超音波顯示腹部有顯性濾泡(10x10mm),但是在乳房位置並沒有濾泡生長的跡象。
  
  Kim醫生表示,卵巢移植的問題在於局部缺血的危害,因為在這項手續上我們並沒有連接血管,之所以選擇直肌做為移植部位是因為它的高度血管性,選擇乳房細胞是因為它的雌激素依賴性與卵巢組織類似。但是移植到這位置並不成功,可能是因為循環不如直肌部位。
  
  卵巢功能於移植後31週終止,原因是因為測量FSH的減少及測不到的雌激素濃度做為量測依據,目前的研究證實了異位自體移植解凍的人類卵巢細胞後,會恢復內分泌功能及自發性排卵。

Autotransplantation of Thawed<

By Emma Hitt, PhD
Medscape Medical News

Oct. 16, 2003 — Thawed ovarian tissue autotransplanted into a human subject caused temporary restoration of endocrine function and spontaneous ovulatory function, indicating a promising strategy for fertility conservation in women with cancer, new research suggests.

S. Samuel Kim, MD, from the Eulji University School of Medicine, in Seoul, Korea, and colleagues presented their findings in an oral presentation Wednesday at the 59th annual meeting of the American Society of Reproductive Medicine in San Antonio, Texas.

According to the researchers, previous reports have suggested that fresh ovarian tissue can regain its ovulatory function after heterotopic autotransplantation, but this has not been demonstrated with cryopreserved ovarian tissue.

The study was conducted in only one patient, but Dr. Kim told Medscape in a phone interview that he would expect this procedure to work in other patients. Furthermore, although the report states that the initial transplant ceased working after 31 weeks, a subsequent transplant of frozen tissue into the same patient continues to function one year after transplant, he said.

In their report, Dr. Kim and colleagues describe the case of a 37-year-old regularly menstruating woman diagnosed with stage Ib squamous cell carcinoma of the cervix. The woman was scheduled for radical hysterectomy, lymph node dissection, and radiotherapy. Before treatment, the patient consented to bilateral salpingo-oophorectomy to preserve her ovarian tissue.

The ovaries, sliced into thin cortical sections (1 x 1 x 5 mm), were frozen and stored in liquid nitrogen. For autotransplantation, 40 cortical sections of stored ovarian tissue were thawed and separated into two groups. The researchers transplanted one group into the space between the pectoralis muscle and breast tissue and the other group into the space between the rectus sheath and the rectus muscle.

Dr. Kim and colleagues measured serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and progesterone. For 10 weeks after transplantation, blood hormone levels "...were consistent with a postmenopausal state," the researchers report.

However, after 14 weeks, hormone levels indicated the reestablishment of ovarian function. Serum estradiol was 57.5 pg/mL and FSH was 39 IU/L. In addition, a dominant follicle was detected (8.5 x 11 mm).

Starting 24 weeks after transplantation, hormone levels were measured every two days for five weeks. During this stage, spontaneous ovulation was indicated by a surge of LH (69.8 IU/L) followed by increased levels of progesterone (9.6 ng/mL). Before the LH surge, estradiol level was 305 pg/mL.

Ultrasound revealed a dominant follicle (10 x 10 mm) in the abdominal site but no sign of follicular development in the breast site.

"A problem of ovarian transplantation is ischemic damage — we are not connecting blood vessels in this procedure," Dr. Kim said. "Therefore, we selected the rectus muscle as a location because it is highly vascular," he said. Breast tissue was selected because of its estrogen dependence, similar to ovarian tissue. "But transplant to this location did not work well, probably because the circulation is not as good as it is to the rectus muscle," Dr. Kim explained.

Ovarian function ceased around 31 weeks after transplantation, as measured by decreased FSH and undetectable estradiol levels.

"The present study demonstrated not only restoration of endocrine function but also spontaneous ovulation after heterotopic autotransplantation of frozen-thawed human ovarian tissue," the researchers conclude in their abstract.

The study was independently funded. The authors reported no pertinent financial disclosures.

ASRM 2003 Annual Meeting: Abstract O-248. Presented Oct. 15, 2003.

Reviewed by Gary D. Vogin, MD

    
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