卵巢移植後第一次成功生產


  June 10, 2005 - 在6月7日提早出版的新英格蘭醫學期刊中發表了一項個案報告,該報告詳述了卵巢移植後第一次成功生產的案例。
  
  密蘇里州聖路易士市聖路克醫院的Sherman J. Silber醫師指出,需使用具性腺毒性或放射線來治療新生腫瘤及其他疾病的婦女數目越來越多,存活者會喪失生育能力,於是,卵巢移植的可能性就愈加受到重視;如果卵巢移植證明可以安全有效的在人體上進行,生育能力即可獲得保持,因為社會因素或醫療因素而必須延緩生產的婦女可因此獲益。
  
  這個個案是有關於兩位24歲的同卵雙胞胎女性,一位在14歲的時候患了卵巢發育不全症而不孕,另一位則有正常的卵巢,也由自然受孕而產下三個小孩;不孕者在卵子捐贈治療失敗後,進行迷你剖腹手術,並移植其姊妹所捐贈的卵巢外皮組織;移植後三個月,受贈者即恢復月經,血液中的促性腺激素濃度亦降低至正常值;她在第二個循環期中受孕,懷孕期間正常,在第38週時產下一位健康的女嬰。
  
  會選擇卵巢外皮作為移植體,是因為侵犯性最低;較之血管移植體,外皮組織的移植手術風險較低,恢復期也較短;不像血管吻合術,外皮組織移植可以進行低溫的冷凍保存,必要時,可供未來卵巢移植所用;外皮移植有一項限制,亦即,在移植體新生血管之前,缺血的現象可能會導致囊泡閉鎖,可能會影響卵巢在長期上的功能。
  
  Silber醫師表示,在第二個週期的第三天(接受她姊妹的三分之二個卵巢後),受贈者的血液FSH(囊泡刺激荷爾蒙)濃度有降低的現象,卵巢功能迅速恢復正常;這些現象顯示,此時月經已恢復正常,患者已可受孕;雖然同卵雙胞胎的卵巢移植很罕見,但這個個案證實了卵巢移植後,卵巢功能可以恢復,能夠自然受孕並成功的懷孕生產;這個結果暗示著,年輕女性若因癌症的治療而導致不孕時,還是可以藉由此法保存生育能力。

First Successful Delivery Foll

By Laurie Barclay, MD
Medscape Medical News

June 10, 2005 — A case report published in the June 7 Early Release issue of the New England Journal of Medicine describes the first successful delivery following ovarian transplantation.

"With the rise in the number of young survivors of neoplastic and other diseases who are rendered sterile by gonadotoxic drugs or radiation, the possibility of ovarian transplantation in humans is receiving increased attention," write Sherman J. Silber, MD, from St. Luke's Hospital in St. Louis, Missouri, and colleagues. "If ovarian transplantation is proven to be safe and effective in humans, fertility preservation might become readily available for young women who need to delay childbearing for medical or social reasons."

This case report describes monozygotic 24-year-old twins, one with premature ovarian failure at age 14 years and the other with normal ovaries and three naturally conceived children. After failure of egg-donation therapy, the sterile twin underwent minilaparotomy and transplantation of ovarian cortical tissue from her sister. Within three months after transplantation, the recipient's menses resumed and serum gonadotropin levels decreased to normal. She conceived during the second cycle, had an uneventful pregnancy, and was delivered of a healthy-appearing female infant at 38 weeks' gestation.

Grafting of ovarian cortex was chosen because it is minimally invasive, with less risk and recovery time than a vascular graft. Unlike vascular anastomosis, cortical grafting also allows cryopreservation of additional ovarian tissue for future transplantation, if needed. An important limitation of cortical grafting is the potential for follicle atresia during the period of ischemia before the tissue becomes revascularized, which might compromise long-term ovarian function.

"The recipient's low levels of serum FSH [follicle-stimulating hormone] on day 3 of the second cycle (after she had received only two thirds of one ovary from her sister) and the rapid return of normal ovarian function suggest that normal menstrual cycles and fertility may resume in this patient after pregnancy," the authors write. "Although ovarian transplantation between monozygotic twins will be rare, the demonstration that ovarian function can be restored and that natural conception and successful pregnancy can be achieved after transplantation of ovarian tissue may have broader implications for preserving fertility in young women, such as those who require potentially sterilizing treatment for cancer."

N Engl J Med. Posted online June 7, 2005.

Reviewed by Gary D. Vogin, MD

    
相關報導
高脂肪飲食與精子品質降低有關
2012/3/20 上午 10:40:33
國際性核准:Seasonale、Pergoveris、Tambocor
2007/8/14 下午 05:54:00
許多青少年擔心不孕
2006/5/30 下午 01:44:00

上一頁
   1   2  




回上一頁