Fertilitätserhalt bei Patienten in der Dermatoonkologie – Eine aktuelle Übersicht

Zusammenfassung

Bei vielen Patienten, die an einem Malignom erkranken, ist die Familienplanung noch nicht abgeschlossen, sodass für den Erhalt des fertilen Potenzials Maßnahmen der Fertilitätsprotektion sinnvoll sind. Durch eine Polychemotherapie, unabhängig ob im neoadjuvanten oder adjuvanten Setting, Molekular- oder Immuntherapien kann es zu einer irreversiblen Schädigung der Follikel bzw. Spermatogenese kommen, was u. U. zu einer permanenten Infertilität führen kann. Abhängig von der verwendeten Therapie und der altersabhängigen Ovarialreserve der Frau muss das gonadotoxische Risiko als niedrig, mittel oder hoch eingeschätzt werden. Möglichkeiten des Fertilitäserhalts sind: a) die Kryokonservierung von fertilisierten oder unfertilisierten Oozyten. Hierbei werden nach ovarieller Hyperstimulation reife Oozyten mittels transvaginaler Follikelaspiration gewonnen und im Anschluss entweder unfertilisiert oder nach erfolgter IVF- oder ICSI-Behandlung kryokonserviert. Bei b) der Kryokonservierung von Ovarialgewebe wird mithilfe eines laparoskopischen Eingriffs etwa 50 % des Ovarkortex eines Ovars reseziert und kryokonserviert. Die Verwendung von c) GnRH-Agonisten als medikamentöse Therapieoption unternimmt den Versuch einer endokrinen Ovarialsuppression, um Oozyten, Granulosa- und Thekazellen vor dem zytotoxischen Einfluss der jeweiligen Therapie zu schützen. Bei männlichen Patienten können Spermien vor Therapiebeginn kryokonserviert werden.

Abstract

In many patients suffering from malignant tumours, family planning is not yet complete, so that fertility protection measures are useful for maintaining fertile potential. Polychemotherapy, whether in the neoadjuvant or adjuvant setting, molecular or immune therapies, can cause irreversible damage to the follicles or spermatogenesis, which may lead to permanent infertility. Depending on the therapy used and the age-related ovarian reserve of the woman, the gonadotoxic risk must be assessed as low, medium or high. Possible ways of preserving fertility are: a) the cryopreservation of fertilised or unfertilised oocytes. After ovarian hyperstimulation, mature oocytes are obtained by transvaginal follicle aspiration and then either unfertilized or cryopreserved after IVF or ICSI treatment. In b) cryopreservation of ovarian tissue, about 50 % of the ovarian cortex of an ovary is resected and cryopreserved by means of a laparoscopic procedure. The use of c) GnRH agonists as a drug therapy option is an attempt at endocrine ovarian suppression to protect oocytes, granulosa and theca cells from the cytotoxic influence of the respective therapy. In male patients, sperm can be cryopreserved before the start of therapy.

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