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Abstract
Germ cell ovarian tumors (malignant ovarian germ cell tumors – MOGCT) affect young women and are treated by surgery plus chemotherapy. It is well known that cytotoxic treatment may accelerate depletion of the primordial follicle pool leading to impaired fertility and premature menopause. Aim of this study is to identify patient candidates for fertility preservation strategies. We report our experience in preservation of fertility for four patients affected by MOGCT, referred to San Raffaele Hospital Oncofertility Unit. All patients received fertility sparing surgery plus platinum-based chemotherapy. Two patients were affected by mixed germ cell tumors and two by disgerminomas. After 24 months from the end of treatment, serum AMH levels have been measured. We report lower serum anti-Mullerian hormone (AMH) levels in our patients than in healthy general population as serum AMH levels were under the 25th age-specific percentiles. Fertility preservation, in terms of oocytes cryopreservation, was offered to those two patients with serum AMH levels predictive of significantly poor ovarian reserve (1st and 2nd patients). Using the gonadotropin releasing hormone (GnRH) antagonist protocol for ovarian stimulation, we obtained two and six oocytes, respectively.
Therefore, serum AMH, as a marker of ovarian function, can improve the identification of patients that need to be referred to fertility preservation strategies.
Chinese abstract
卵巢恶性生殖细胞肿瘤（MOGCT）好发于年轻女性，常用手术加化疗进行治疗。众所周知，化疗的细胞毒性作用会加速始基卵泡的消耗，导致生殖功能受损及过早绝经。本研究的目的是找出保留患者生育能力的策略。我们报道了对San Raffaele医院肿瘤生殖科的四位MOGCT患者保留其生育功能方面的体会。所有患者接受保留生育功能手术加以铂为基础的化疗方案。两名患者罹患混合性生殖细胞肿瘤，另两名为无性细胞瘤患者。治疗结束24个月后，测其血清AMH水平。我们发现患者的血清抗苗勒氏管激素（AMH）水平较健康人群低，其血清AMH水平低于不同年龄层的第25百分位数。对于血清AMH水平极低并因此预测到其卵巢功能显著受损的第一、二名患者，保存其生殖能力如卵母细胞冷冻保存。用促性腺激素释放激素（GnRH）拮抗剂方案促排卵，我们分别获得2个和6个卵母细胞。因此，血清AMH可作为监测卵巢功能的一项指标，提高我们对需要施行生育能力保存方案的患者的鉴别能力。