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Abstract Objective The present study aimed to develop a useful mathematical model that predicts the age at which premature ovarian insufficiency might occur after teletherapy radiation. A diagnosis of premature or early menopause has physical and psychological consequences, so women may need support and long-term medical follow-up. Methods To correlate ovarian radiation dose with ovarian function, we used the formula described by Wallace et al.: √g(z) = 10(2-0,15z), where "g(z)" and "z" represent oocyte survival rate and the radiation dose (in Gray), respectively. By simulating different ages and doses, we observed a pattern that could be used to simplify the relationship between radiation dose and remaining time of ovarian function. Results We obtained a linear function between ovarian radiation dose and loss of ovarian function (LOF) that is the percentage of decrease in the time to the ovarian failure compared with the time expected for a woman at the same age without irradiation exposition. For patients <40 years old and with ovarian radiation doses < 5 Gy, the equation LOF = 2.70 + (11.08 × Dose) can be applied to estimate the decrease in time to premature ovarian insufficiency. Conclusion The present study reports a practicable theoretical method to estimate the loss of ovarian function. These findings can potentially improve the management and counseling of young women patients submitted to radiotherapy during their reproductive years.
Resumo Objetivo O presente estudo teve como objetivo desenvolver um modelo matemático útil que prediz a idade na qual a insuficiência ovariana prematura pode ocorrer após a radioterapia externa (teleterapia). O diagnóstico de menopausa prematura ou precoce tem consequências físicas e psicológicas; portanto, as mulheres podem precisar de apoio e acompanhamento médico de longo prazo. Métodos Para correlacionar a dose de radiação ovariana com a função ovariana, foi usada a fórmula descrita por Wallace et al.: √g(z) = 10(2-0,15z), na qual "g(z)" e "z" representam a taxa de sobrevivência do oócito e a dose de radiação (em Gray), respectivamente. Ao simular diferentes idades e doses, observamos um padrão que poderia ser usado para simplificar a relação entre a dose de radiação e o tempo restante da função ovariana. Resultados Obtivemos uma função linear entre a dose de radiação ovariana e a perda da função ovariana (LOF, na sigla em inglês) que é a porcentagem de diminuição no tempo até a falência ovariana em relação ao tempo esperado para uma mulher da mesma idade sem exposição à radiação. Para pacientes<40 anos de idade e com doses de radiação ovariana < 5 Gy, a equação LOF = 2,70 + (11,08 × Dose) pode ser aplicada para estimar a redução no tempo até a insuficiência ovariana. Conclusão O presente estudo relata um método teórico viável para estimar a perda da função ovariana. Estes achados podem melhorar potencialmente o manejo e o aconselhamento de pacientes jovens submetidas à radioterapia durante seus anos reprodutivos.
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Humans , Female , Ovarian Function Tests , Ovary/radiation effects , Primary Ovarian InsufficiencyABSTRACT
OBJ ECTIVE To study the effect a nd mechanism of modified Yijing decoction on the decrease of ovarian reserve function（DOR）in rats. METHODS A total of 140 SPF female SD rats were randomly divided into control group ，model group ， positive control group （Estradiol valerate tablets 0.09 mg/kg），inhibitor group [modified Yijing decoction 23.6 g/kg+transcriptional inhibitor for hypoxia inducible factor- 1α（HIF-1α）YC-1 2 mg/kg] and modified Yijing decoction low-dose ，medium-dose and high-dose groups （5.9，11.8，23.6 g/kg）. Except for control group ，rats in other groups were given cyclophosphamide via femoral vein to induce DOR model ；after successful modeling for 2 h，rats in each group were given normal saline or relevant medicine intragastrically，once a day ，for 8 consecutive weeks.The estrous cycle of rats in each group was recorded ，and the ovarian index was calculated to observe the histopathological changes and autophagy in the ovary ；serum levels of follicle stimulating hormone （FSH），luteinizing hormone （LH），anti-Müllerian hormone （AMH）and estrogen （E2）were measured ；protein and mRNA levels of HIF-1α，B lymphoblastoma 2 gene/adenovirus E 1B interacting protein 3 recombinant protein （Bnip3）and yeast Atg 6 homolog of autophagy key molecule （Beclin1）in ovarian tissues of rats were all detected. RESULTS Compared with control group ，the ovarian indexes of model group and administration groups were decreased significantly （P＜0.05）. Model group possessed disturbed estrous cycle and the ovary tissues showed pathological morphology ，the autophagolysosomes appeared in ovary cells ，AMH and E 2 levels were significantly decreased （P＜0.05）；FSH and LH levels ，protein and mRNA expressions of HIF- 1α，Bnip3 and Beclin 1 were significantly increased （P＜0.05）. Compared with model group ，the estrous cycle of rats in positive control group and modified Yijing decoction groups gradually returned to normal ，the pat hological morphology of ovarian tissue and the autophagy of ovarian cells were improved ；the ovarian index ，AMH and E 2 levels were significantly increased （P＜0.05）；the levels of FSH and LH ，protein and mRNA expressions of HIF- 1 α ， Bnip3 and Beclin 1（except for protein of HIF- 1α，protein and wanyunhui188@163.com mRNA of Bnip 3 in modified Yijing decoction low-dose group ） were decreased significantly （P＜0.05）. The protein expressions of H IF-1α，Bnip3 and Beclin 1，mRNA expressions of HIF- 1α and Beclin 1 were decreased significantly in the inhibitor group （P＜0.05）. CONCLUSIONS Modified Yijing decoction can improve ovarian function ，regulate the secretion of sex hormone ，and protect ovarian tissue in DOR model rats ，and the mechanism of which may be related to the inhibition of HIF- 1α/ Bnip3/Beclin1 pathway.
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Objective:To explore the relationship between serum anti-Müllerian hormone (AMH) level and related clinical factors in healthy females, and establish and validate equation of correlation between age and serum AMH level for healthy females.Methods:From March 2015 to December 2016, a total of 602 females who measured serum AMH level in Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University were retrospectively enrolled. All cases had relatively complete clinical data, and were divided into healthy group (484 cases, 20-52 years) and case group (118 cases, 20-42 years; patients with menstrual disorders). Relationships between serum AMH level and estradiol (E2), tesosterone (T), follicle stimulating hormone (FSH), luetinizing hormone (LH), body mass index (BMI) of healthy group were analyzed by Spearman rank correlation. Kruskal-Wallis rank sum test was used to analyze the relationship between history of gestation and serum AMH level. Serum AMH level of health group was processed to establish predictive equation for serum AMH level. Internal ( n=27) and external ( n=37) validation group were chosen from healthy females with serum AMH level measured to validate the equation, and signed rank test was used to analyze the data. Difference between serum AMH level in case group and healthy group with corresponding age was explored by independent-sample t test. Results:Serum AMH levels were positively correlated with E2 and T ( rs values: 0.263, 0.334, both P<0.001), and negatively correlated with FSH, LH, BMI ( rs values: from -0.515 to -0.110, all P<0.005). Predictive equation was established as LogAMH=-1.208+ 0.1×age-0.000 042×age 3 ( R2=0.735, P<0.001). No statistically significant difference was found between real serum AMH levels and calculated serum AMH levels in the internal and external validation groups ( z values: -1.62 and -1.52, both P>0.05). Females in case group ( n=118) and control group ( n=446) were divided into two sub-groups respectively (<35 years and ≥35 years), and serum AMH levels of case group were lower than those of control group with corresponding age ( t values: 18.64, 11.70, both P<0.001). Conclusions:In healthy females, serum AMH level is related to some clinical data. The equation between serum AMH level and age established in the study may provide reference for clinical diagnosis and treatment.
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Objective:To investigate the efficacy of gonadotropin releasing hormone agonist (GnRH-a) combined with a levonorgestrel-releasing intrauterine system (Mirena) in patients with adenomyosis and its effects on ovarian function, carbohydrate antigen (CA) 125, CA153 and carcino-embryonic antigen (CEA) expression.Methods:Seventy-eight patients with adenomyosis who received treatment from September 2017 to September 2020 in Shaoxing People's Hospital were included in this study. They were randomly divided into treatment and control groups ( n = 39/group). Patients in the control group were treated with a levonorgestrel-releasing intrauterine system. Patients in the treatment group were treated with GnRH-a, once per month in the first 3 months based on treatment with a levonorgestrel-releasing intrauterine system. After 6 months of treatment, changes in dysmenorrheal relief, menstrual volume, uterine volume, endometrial thickness, ovarian function, CA125, CA153 and CEA levels relative to before treatment were compared. Results:Visual analog scale score and pictorial blood assessment chart score in the treatment group were (1.36 ± 0.28) points and (38.98 ± 5.42) points, which were significantly lower than those in the control group [(1.78 ± 0.31) points, (63.42 ± 6.75) points, t = 6.27, 17.63, both P < 0.05). Uterine volume and endometrial thickness in the treatment group were (209.74 ± 15.65) cm 3 and (7.37 ± 0.57) mm, respectively, which were significantly lower than those in the control group [(278.39 ± 20.90) cm 3, (8.63 ± 0.86) mm, t = 16.45, 7.62, P < 0.05]. There were no significant differences in serum levels of luteinizing hormone, follicle stimulating hormone and estradiol between the two groups (all P > 0.05). Serum CA125, CA153 and CEA levels in the treatment group were (26.87 ± 7.21) U/L, (23.12 ± 7.38) U/mL and (5.45 ± 0.96) μg/L, respectively, which were significantly lower than those in the control group [(49.93 ± 8.97) U/L, (38.94 ± 6.21) U/mL, (8.23 ± 1.35) μg/L, t = 12.51,10.24,10.48, P < 0.05]. Conclusion:GnRH-a combined with a levonorgestrel-releasing intrauterine system (Mirena) can markedly relieve dysmenorrhea, reduce menstrual volume, uterine volume, and endometrial thickness, has no obvious effects on ovarian function, and greatly reduce the levels of CA125, CA153 and CEA. Therefore, the combined method is a safe and effective non-surgical treatment method of adenomyosis.
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Chitooligosaccharide-zinc (COS·Zn) is a powerful anti-oxidant and anti-aging scavenger, whose anti-oxidative ability immensely exceeds vitamin C. Therefore, this study was aimed to investigate the protective effects of COS·Zn against premature ovarian failure (POF) and potential mechanisms. Female KM adult mice were divided into the following groups: a treatment group (150 mg·kg
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Animals , Female , Humans , Mice , Chitosan , NF-E2-Related Factor 2/genetics , Nuclear Proteins , Oligosaccharides , Primary Ovarian Insufficiency/drug therapy , Signal Transduction , ZincABSTRACT
OBJECTIVES: Female breast cancer patients generally have limited knowledge regarding issues related to preservation of ovarian function and fertility. The present study aimed to explore the change in the understanding of these issues when female breast cancer patients are educated and counseled about ovarian function and fertility after anticancer treatment.METHODS: One hundred nine young female breast cancer patients completed a questionnaire, which revealed their thoughts and opinions before and after receiving the education about ovarian function and fertility. Their responses were analyzed to determine the impact of the education on their perception and understanding of the aforementioned issues.RESULTS: The objective survey had four main themes: planning and desire for children, degree of baseline understanding of the effects of anticancer therapy on fertility and ovarian function, resultant change in cognition after education about cancer treatment and its relationship with fertility, and need for education regarding the types of therapies received and their effects on subsequent ovarian function and fertility before treatment.CONCLUSIONS: The preservation of ovarian function and fertility is an important factor that must be included in the discussion prior to initiation of anticancer therapy. Although the study results do not have high educational effectiveness or a high satisfaction with education, there is a need for information and education regarding the impact of anticancer treatment on preservation of ovarian function and fertility.
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Child , Female , Humans , Breast Neoplasms , Breast , Cognition , Education , FertilityABSTRACT
Objective@#The correlation between dosimetric parameters of transposed ovary and different clinical ovarian functional status was assessed in young patients with cervical cancer who needed adjuvant radiotherapy after radical resection of the ⅠB1-ⅡA2 phase of preserved and transposed ovaries.@*Methods@#The function of transposed ovary and relevant clinical symptoms in 86 patients before and 2 years after treatment between 2015 and 2017 were retrospectively analyzed, and the correlation between the dosimetric parameters and functional status of transposed ovaries during radiotherapy was evaluated. Different in vitro measures were adopted to protect the transposed ovaries during postoperative radiotherapy including 68 cases of IMRT or VMAT and 18 cases of two-dimensional and other central radiotherapy.@*Results@#The nearest distance between ovary and PTV was negatively correlated with the ovarian dose ≥V5 Gy (P=0.025). V8 Gy and Dmean were positively correlated with FSH after treatment (P=0.011, 0.020). The larger the volume of V8 Gy and the large Dmean, the higher the FSH, the worse the ovarian function. In two-dimensional technology, the ovarian dose ≥V5 Gy was significantly lower than that in three-dimensional technique. The average age of those with normal ovarian function after treatment was 33.4 years, whereas the average age of women with ovarian failure was 39.6 years (P=0.007). The number of preserved ovaries and whether synchronous chemotherapy was delivered were similar in patients with different ovarian status, which were correlated with the levels of FSH and E2 (Estradiol) before treatment, that is, the higher the level of FSH before treatment, the lower the E2 of ovarian FSH after treatment, and the higher the level of FSH after treatment, the lower the level of ovarian E2. Patients who retained their ovaries before treatment but suffered from ovarian failure received neoadjuvant chemotherapy with a slightly higher age.@*Conclusions@#Age, V8 Gy and Dmean of the transposed ovary, the shortest distance between transposed ovary and PTV, whether neoadjuvant chemotherapy was delivered before surgery and radiotherapy technique affect the protection of the function of transposed ovary.
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Objective The correlation between dosimetric parameters of transposed ovary and different clinical ovarian functional status was assessed in young patients with cervical cancer who needed adjuvant radiotherapy after radical resection of the Ⅰ B1-Ⅱ A2 phase of preserved and transposed ovaries.Methods The function of transposed ovary and relevant clinical symptoms in 86 patients before and 2 years after treatment between 2015 and 2017 were retrospectively analyzed,and the correlation between the dosimetric parameters and functional status of transposed ovaries during radiotherapy was evaluated.Different in vitro measures were adopted to protect the transposed ovaries during postoperative radiotherapy including 68 cases of IMRT or VMAT and 18 cases of two-dimensional and other central radiotherapy.Results The nearest distance between ovary and PTV was negatively correlated with the ovarian dose ≥ V5 Gy (P=0.025).Vs Gy and D were positively correlated with FSH after treatment (P=0.011,0.020).The larger the volume of Vs Gy and the large D the higher the FSH,the worse the ovarian function.In two-dimensional technology,the ovarian dose ≥ V5 Gy was significantly lower than that in three-dimensional technique.The average age of those with normal ovarian function after treatment was 33.4 years,whereas the average age of women with ovarian failure was 39.6 years (P=0.007).The number of preserved ovaries and whether synchronous chemotherapy was delivered were similar in patients with different ovarian status,which were correlated with the levels of FSH and E2 (Estradiol) before treatment,that is,the higher the level of FSH before treatment,the lower the E2 of ovarian FSH after treatment,and the higher the level of FSH after treatment,the lower the level of ovarian E2.Patients who retained their ovaries before treatment but suffered from ovarian failure received neoadjuvant chemotherapy with a slightly higher age.Conclusions Age,V8 Gy and D of the transposed ovary,the shortest distance between transposed ovary and PTV,whether neoadjuvant chemotherapy was delivered before surgery and radiotherapy technique affect the protection of the function of transposed ovary.
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Anti-Müllerian hormone (AMH),a dimer glycoprotein secreted by sustentacular cells of testis and ovarian granulosa cells,belonging to the transforming growth factor β super-family.AMH is able to regulate follicular development and participate in follicular growth process,and it is relatively constant throughout the menstrual cycle compared with other ovarian reserve indicators.At present,AMH is widely used to evaluate ovarian reserve and to diagnose and evaluate the development and prognosis of ovarian diseases.It has been increasingly applied in the field of female assisted reproduction in recent years.With the development of detection technology,the sensitivity and accuracy of methods for detecting AMH are gradually improved.This review summarizes the research background,mechanism of action,clinical applications and detecting methods of AMH.
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Objective To evaluate the effect of anti-Mueller hormone on ovarian reserve in female patients with systemic lupus erythematosus(SLE).Methods The clinical data of 80 women with SLE in the Department of Rheumatism of Zaozhuang Municipal Hospital from June 2015 to June 2018 were collected.The patients used cyclophosphamide before entering the group were selected as A group (35 cases),and patients who didn't use cyclophosphamide were selected as B group(45 cases),and 30 healthy female volunteers were selected as the control group at the same time.All of them were normal menstrual cycle.At the third day of the menstrual cycle,the levels of anti-Mueller hormones were detected by enzyme linked immunosorbent assay.The serum levels of estrogen and alveolar hormone were detected by microparticle enzyme immunoassay,and the number of ovarian sinus follicles in each group was recorded by transvaginal ultrasound.Results The incidence rate of thrombocytopenia,nephritis,hemolytic anemia and neuropsychiatric manifestations in A group were 54.29％ (19/35),85.71％ (30/35),37.14％ (13/35) and 22.86％ (8/35),respectively,which were significantly higher than those in B group [48.89％ (22/45),53.33％ (24/45),13.33％ (6/45),0.00％ (0/45)] (x2 =6.33,9.41,6.16,9.03,all P ＜0.05).The number of anti-Mueller hormone [(1.09 ± 0.33) g/L] and numbers of ovarian sinus follicle [(8 ± 2)] in A group were significantly lower than those in B group [(1.98 ± 0.62) g/L,(12 ± 4)] and control group [(3.37 ± 1.11) g/L,(15 ± 5)],which showed significant differences (F =46.07,25.90,all P ＜ 0.05),but there were no statistically significant differences in serum estrogen and follicular stimulating hormone levels among the three groups(F =1.16,0.97,all P ＞ 0.05).The level of anti-Mueller hormone in patients with SLE aged ＞ 30 years [(0.98 ± 0.31) g/L]was significantly lower than patients ≤30 years old[(1.86 ±0.60) g/L],and the level of anti-Mueller hormone in patients with cyclophosphamide accumulation ＞ 10 g[(0.36 ± 0.11) g/L] was significantly lower than that of 10 g [(1.76 ± 0.52) g/L] (t =7.54,11.30,both P ＜ 0.01).The results of Pearson correlation analysis showed that the anti-Mueller hormone showed negative correlation with the age of SLE and the accumulation of cyclophosphamide (r =-0.56,-0.45,both P ＜ 0.01).Conclusion The use of anti-Mueller hormone has good evaluation value for ovarian reserve function in female patients with SLE,and the level of anti-Mueller hormone is closely related to the age and the accumulation of cyclophosphamide.Therefore,cyclophosphamide should be used carefully in patients who are over 30 years old and the cumulative amount of cyclophosphamide over 10 g.
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Objective To investigate the effect of Huoxue-Xiaozheng decoction on ovarian function and mifepristone of in patients with uterine leiomyoma after operation.Methods A total of 90 patients with uterine leiomyoma after operation were divided into the observation group and control group according to random number table method,with 45 cases in each group.The control group were treated with mifepristone,and the observation group with Huoxue-Xiaozheng decoction on the basis of the control group.The serum sex hormone (FSH,LH,E2,P and T),cell factor (TGF-β3,IL-22,FSH,LH,E2,P and T) and the uterine volume between two groups after treatment were compared,and the recurrence rate of uterine leiomyoma was compared between the two groups after treatment.Results After treatment,the serum sex hormone FSH (17.11 ± 4.01 μg/L vs.20.16 ± 5.21 μg/L,t=3.112),LH (16.78 ± 3.34 μg/L vs.19.52 ± 4.32 μg/L,t=3.366),E2 (156.60 ± 46.32 pmol/L vs.220.31 ± 50.11 pmol/L,t=6.263),P (8.37 ± 2.50 μg/L vs.15.23 ± 2.45 μg/L,t=13.1467),T (0.23 ± 0.05 ng/ml vs.0.31± 0.06 ng/ml,t=6.8712),cell factor TGF-β3 (22.08 ± 4.34 μg/L vs.28.10 ± 5.02 μg/L,t=6.086) of the observation group were significantly lower than those of the control group (P＜0.01).After treatment,the uterine volume (85.42 ± 19.35 cm3 vs.97.37 ± 20.45 cm3,t=2.847) of the observation group was significantly lower than that of the control group (P＜0.01).After 2 years of follow-up,the uterine fibroids overall recurrence rate of the observation group was 13.3％ (6/45),while the control group was 31.1％ (14/45),.The difference between two groups,was statistically significant (x2=4.114,P=0.043).Conclusions The Huoxue-Xiaozheng decoction combined with mifepristone can effectively inhibit the secretion of ovarian hormones and decrease the expression of TGF-β3,IL-22,FSH,LH,E2,P and T in patients with uterine leiomyoma.
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Objective To evaluate systematically the effectiveness of gonadotropin-releasing hormone agonist (GnRHa) administration before chemotherapy and/or during chemotherapy for the protection of ovarian function in premenopausal women. Methods PubMed, Cochrane Library, Medline, Embase, China Biomedical Literature Database, CNKI were searched to collect the clinical randomized control trail (RCT) of ovarian function protection in premenopausal women receiving chemotherapy by using GnRHa. RevMan5.3 software was used to analyze the incidence of early premature ovarian insufficiency (POI), menstrual recovery rate, pregnancy rate and other indicators. Results A total of 12 articles were included, including a total of 1509 premenopausal women who received chemotherapy for malignant diseases. GnRHa combined with chemotherapy reduced the incidence of POI (OR = 0.36, 95％ CI 0.23-0.56, P < 0.01) and improved the menstrual recovery rate during follow-up (OR = 2.49, 95％ CI 1.72-3.60, P < 0.01). GnRHa combined with chemotherapy could increase the pregnancy rate of patients aged 35 years and older (OR = 2.04, 95％ CI 1.08-3.83, P = 0.03). Conclusion GnRHa administration before chemotherapy and/or during chemotherapy may prevent the chemotherapy damage to ovarian function, reduce the incidence of POI, and improve the recovery rate of menstruation.
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Gonadotropin-releasing-hormone analogues (GnRHa) are widely used in the treatment of premenopausal breast cancer. The anti-tumor effect of GnRHa is similar to that of surgical castration or chemotherapy, through reversibly inhibiting ovarian function and downregulating the estrogen level in premenopausal female. At the same time, GnRHa can protect the ovarian function, avoiding premature ovarian failure. Also GnRHa can reduce the breast density and endometrial thickness, as a result of which GnRHa may be used to prevent breast cancer in the higher risk population and promote quality of life in breast cancer patients. We here review the clinical roles and research progress of GnRHa in breast cancer.
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Objective@#To investigate the effect of pituitrin-water separation on hemoglobin and ovarian function in laparoscopic ovarian chocolate cyst removal.@*Methods@#From February 2018 to February 2019, 82 patients with ovarian chocolate cyst removed by laparoscopy were selected from the Second Affiliated Hospital of Wenzhou Medical University.They were randomly divided into observation group and control group according to the digital table, with 41 cases in each group.The control group underwent traditional laparoscopic tear-and-tear ovarian cyst removal, while the observation group underwent pituitrin-water separation.The changes of perioperative indicators, the decrease of hemoglobin (Hb) before and after operation, the positive rate of normal ovarian tissue on cyst wall and the number of normal follicles attached to cyst wall, the changes of serum hormone levels before and after operation were compared between the two groups.@*Results@#The amount of bleeding during operation in the observation group [(58.97±8.74)mL] was less than that in the control group [(118.93±24.21)mL], and the operation time in the observation group[(57.46±8.27)min] was shorter than that in the control group [(87.38±10.19)min] , the differences were ststistically significant between the two group(t=14.916, 14.598, all P<0.05). There was no statistically significant difference in the time of anal exhaust between the two groups (P>0.05). The decrease of Hb in the observation group [(0.71±0.16)g/L] was lower than that in the control group [(1.27±0.35)g/L] (t=9.318, P<0.05). The positive rate of normal ovarian tissue on cyst wall in the observation group (21.95%) was lower than that in the control group (56.10%), the number of normal follicles attached to the cyst wall in the observation group (2.65±0.49) was less than that in the control group (4.86±1.24) , the differences were ststistically significant between the two group(χ2=10.045, t=10.613, all P<0.05). The serum level of E2 [(398.21±17.84)pmol/L] in the observation group was higher than that in the control group [(367.83±15.21)pmol/L], while FSH [(6.72±0.28)mIU/mL] and LH [(5.23±0.38)mIU/mL] levels in the observation group were lower than those in the control group [(7.19±0.35)mIU/mL and (5.69±0.31)mIU/mL], the differences were ststistically significant between the two group (t=8.298, 6.714, 6.006, all P<0.05).@*Conclusion@#The method of pituitrin-water separation is effective in laparoscopic ovarian chocolate cyst removal, which can reduce the injury during operation, has little effect on hemoglobin and improve the ovarian reserve function of patients.
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Fallopian tube factors and decreased ovarian function are the main causes of female infertility. Decreased ovarian function includes premature ovarian failure, diminished ovarian reserve, premature ovarian insufficiency and poor ovarian response. The main feature of ovarian function decline is the decrease in the number and/or the low quality of ova, manifested as ovulation disorders, infertility and reproductive endocrine disorders. This article summarizes the progress in different evaluation criteria and treatment of decreased ovarian function, hoping to provide reference for future diagnosis and treatment.
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Objective: To evaluate the therapeutic efficacy of gonadotropin-releasing hormone analogues (GnRHa) in protecting ovarian function of premenopausal breast cancer patients undergoing chemotherapy. Methods: The randomized controlled trials of GnRHa protecting ovarian function of premenopausal breast cancer patients undergoing chemotherapy were collected from PubMed, Cochrane Library, EMbase, China National Knowledge Infrastructure (CNKI) and Wanfang Databases, and the date range was from the establishment of the databases to March 2018. According to the inclusion and exclusion criteria, the literatures about amenorrhea rate, premature ovarian failure (POF) rate, menstrual recurrence rate, pregnancy rate, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in premenopausal breast cancer patients after chemotherapy combined with GnRHa or chemotherapy alone were screened out. The outcome measurements were odds ratio (OR) and 95% confidence interval (CI). The Meta-analysis was performed using RevMan 5.3 software. Results: A total of 17 randomized controlled trials involving 1 590 patients were included in this Metaanalysis. As compared with chemotherapy alone, the chemotherapy combined with GnRHa increased the amenorrhea rate during chemotherapy (OR = 11.14, 95% CI: 4.83-25.72, P < 0.000 01), reduced the POF rate (OR = 0.35, 95% CI: 0.25-0.50, P < 0.000 01), while improved the menstrual recurrence rate (OR = 2.90, 95% CI: 1.88-4.49, P < 0.000 01) and pregnancy rate (OR = 1.81, 95% CI: 1.08-3.02, P = 0.02). Moreover, three studies showed that the levels of FSH and LH in chemotherapy combined with GnRHa group were lower than those in chemotherapy alone group, and there were significant differences in two studies (both P < 0.01). Conclusion: Chemotherapy combined with GnRHa can increase the menstrual recurrence rate and pregnancy rate of premenopausal breast cancer patients after chemotherapy, suggesting that GnRHa has a protective effect on ovarian function of those patients.
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Objective To investigate the effect of pituitrin-water separation on hemoglobin and ovarian func-tion in laparoscopic ovarian chocolate cyst removal.Methods From February 2018 to February 2019,82 patients with ovarian chocolate cyst removed by laparoscopy were selected from the Second Affiliated Hospital of Wenzhou Medical University.They were randomly divided into observation group and control group according to the digital table,with 41 cases in each group.The control group underwent traditional laparoscopic tear-and-tear ovarian cyst removal,while the observation group underwent pituitrin-water separation.The changes of perioperative indicators ,the decrease of hemoglobin (Hb) before and after operation ,the positive rate of normal ovarian tissue on cyst wall and the number of normal follicles attached to cyst wall ,the changes of serum hormone levels before and after operation were compared between the two groups.Results The amount of bleeding during operation in the observation group [(58.97 ±8.74)mL] was less than that in the control group [(118.93 ±24.21)mL],and the operation time in the observation group[(57.46 ±8.27) min] was shorter than that in the control group [(87.38 ±10.19) min] ,the differences were ststistically significant between the two group ( t ＝14.916,14.598,all P ＜0.05 ).There was no statistically significant difference in the time of anal exhaust between the two groups (P＞0.05).The decrease of Hb in the observation group [(0.71 ±0.16)g／L] was lower than that in the control group [(1.27 ±0.35) g／L] ( t＝9.318,P＜0.05).The positive rate of normal ovarian tissue on cyst wall in the observation group (21.95%) was lower than that in the control group (56.10%),the number of normal follicles attached to the cyst wall in the obser-vation group (2.65 ±0.49) was less than that in the control group (4.86 ±1.24) ,the differences were ststistically significant between the two group ( χ2 ＝10.045, t ＝10.613, all P ＜0.05).The serum level of E2 [( 398.21 ± 17.84)pmol／L] in the observation group was higher than that in the control group [(367.83 ±15.21) pmol／L], while FSH [(6.72 ±0.28)mIU／mL] and LH [(5.23 ±0.38)mIU／mL] levels in the observation group were lower than those in the control group [(7.19 ±0.35)mIU／mL and (5.69 ±0.31)mIU／mL],the differences were ststisti-cally significant between the two group (t＝8.298,6.714,6.006,all P＜0.05).Conclusion The method of pitui-trin-water separation is effective in laparoscopic ovarian chocolate cyst removal ,which can reduce the injury during operation,has little effect on hemoglobin and improve the ovarian reserve function of patients .
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Improvement in diagnosis has made it possible to have the early detection of gynecologic malignancies.Among premenopausal women,the loss of future fertility or ovarian function is considered among the most dreadful long-term side effects of treatments.Therefore,the preservation of fertility and ovarian function during chemotherapy treatment is of great important.This article will summarize the effect of chemotherapy on ovarian function and protective measures for chemotherapy-induced ovarian damage.
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With the progress of regenerative medicine, mesenchymal stem cells (MSCs) have received attention as a way to restore ovarian function. It has been reported that MSCs derived from bone marrow, adipose, umbilical cord blood, menstrual blood, and amniotic fluid improved ovarian function. In light of previous studies and advances in this field, there are increased expectations regarding the utilization of MSCs to restore ovarian function. This review summarizes recent research into potential applications of MSCs in women with infertility or primary ovarian insufficiency, including cases where these conditions are induced by anticancer therapy.
Subject(s)
Female , Humans , Amniotic Fluid , Bone Marrow , Fetal Blood , Infertility , Mesenchymal Stem Cells , Primary Ovarian Insufficiency , Regenerative MedicineABSTRACT
Ovarian function is the basis of female reproduction. Due to various causes of ovarian function, manstruation, menstrual cramps and infertility may appear. For infertility caused by ovaries, if the roots are traced, the roots may be low ovarian function. The idea of "disease prevention" should be throughout the treatment. "Pregnancy relying on regulating menstruation" theory should be followed, with a purpose to realize the early identification and early treatment.