Endocrine function and fertility preservation in women surviving cancer : a study on cancer treatment and fertility

[摘要] ENGLISH ABSTRACT: Chapter 1 is a literature review investigating the incidence of cancer in children andyoung adults. It describes the most important treatment options includingchemotherapy, radiotherapy and surgery and the effect of treatment on futureendocrine development and fertility. Different primary cancer sites are discussed inmore detail.Chapter 2 is a literature review on the effects of cancer surgery in women and theoptions for fertility sparing. Cervical cancer and pre-cancer are discussed in detailwith options for more conservative surgery in selected patients. A summary of theavailable published cases of trachelectomy with pregnancy outcomes is included.Other gynaecological cancers requiring surgery are also discussed with reference toconservative options.Chapter 3 is a literature review about the medical (pharmacological) options forprotection of ovarian function in patients undergoing oncotherapy. The role ofgonadotrophin releasing hormone analogues and hormonal contraceptives in ovariansuppression is discussed in detail.Chapter 4 This chapter examines germ cell physiology with reference to cryopreservation. Itincludes two major parts. Part 1 is the description of germ cell- and follicle physiology, the principles of cryobiology followed by a review of oocytecryopreservation and ovarian tissue preservation. Both slow freezing and vitrificationtechniques are described. The second part of chapter 4 is a report on a randomisedcontrolled evaluation of two different slow freezing cryopreservation protocols. Thisexperimental study compared ultrastructural changes in fresh and previouslycryopreserved ovarian cortical tissue after equilibration and thawing using twodifferent cryoprotectants. This is the first randomised investigation into DMSO andPROH as cryoprotectants.Chapter 5 is an investigation into cryopreservation of ovarian tissue as a strategy toprotect hormonal function and fertility against gonadotoxic treatment. This chapterconsists of two parts. The first part is a thorough literature review of all the publishedwork about grafting of previously cryopreserved ovarian tissue. The largest caseseries found from a single institution was five patients. Another report of six patientsincluded patients from various sites in Denmark.Part 2 is a description of a cohort of patients followed up after re-implantation ofpreviously cryopreserved ovarian cortical tissue. Follow-up hormone levels of 13individual cases are described in detail. This is the largest case series everreported.The experimental study described in Chapter 4 and the clinical study described inChapter 5 was approved by the ethical research committee of the Faculty of HealthSciences, Stellenbosch University, project number N05/10/182.Chapter 6 provides an integrated overview of the incidence and treatment of cancerin young women and how its negative effects may be prevented or mitigated.Aspects of chemotherapy, radiotherapy and surgery are evaluated where it mayaffect future reproductive health. The role of oocyte and ovarian tissuecryopreservation is discussed. Guidelines are provided for clinicians.

[发布机构] Stellenbosch University