多囊卵巢综合征伴胰岛素抵抗对生育影响的研究进展

多囊卵巢综合征（PCOS）是育龄妇女常见的内分泌性疾病，跨越了妇女生命的全过程，以高胰岛素血症、高雄激素血症和（或）无排卵为特征，目前病因尚不明确，然而胰岛素抵抗（IR）是PCOS患者常见的代谢紊乱性疾病。由此产生的高胰岛素血症可导致激素水平改变、卵泡生长受限、子宫内膜容受性改变，增加流产率或导致不孕等，同时可增加妊娠合并症的发病率，甚至让患者产生焦虑、抑郁等心理问题，因此PCOS伴IR越来越受到人们的重视。阐述PCOS伴IR对生育影响的研究进展。     

Oocytes from stem cells

Folliculogenesis describes the process of activating an oocyte-containing primordial follicle from the ovarian reserve and its development to the mature ovulatory stage. This process is highly complex and is controlled by extra- and intra-ovarian signaling events. Oocyte competence and capacity for fertilization to support a viable pregnancy are acquired during folliculogenesis. Cancer and cancer-based therapies can negatively affect this process, compromising fertility. Currently, preservation of fertility in these patients remains limited to surrogacy, oocyte freezing, oocyte donation, or in vitro maturation (IVM). Recent reports of stem cells being used to produce fully competent oocytes and subsequently healthy offspring in mice have opened up a novel avenue for fertility preservation. However, translating these findings into human health first relies on enhancing our understanding of follicle growth and mimicking its intricacies in vitro. Indeed, the future of oocytes from stem cells in humans comes with many possibilities but currently faces several technical and ethical obstacles.     

Fertility preservation in male patients with cancer

Advances in the treatment of cancer in young patients have led to great improvements in life expectancy, which currently approaches 80% 5-year survival rate. As a result, fertility preservation and desire for paternity have become a significant issue in this group. However, a major concern is the negative impact of chemotherapy, radiotherapy, and the malignancy itself on fertility. Thus, men about to have treatment for malignant conditions may have sperm cryopreserved before commencing chemotherapy or radiotherapy. Ejaculated sperm cryopreservation is the most common technique used. Some patients with cancer may present initially with oligospermia or azoospermia. In cases when a sample is not produced due to medical, social, or religious reasons, sperm can be retrieved using penile vibratory stimulation, electroejaculation, or testicular sperm extraction. Fertility preservation in prepubertal boys presents a great challenge, as sperm banking is not possible. Alternative strategies have been developed, but all are currently experimental.     

Fertility preservation for boys and adolescents facing sterilizing medical therapy

Improvements in childhood cancer survival have allowed boys and their families to increasingly focus on quality of life after therapy, particularly their future ability to father children. Treatments should maintain comprehensive cancer care goals and consider the long-term quality of life of these children. While semen cryopreservation is a well-established method of fertility preservation for post-pubertal children, the use of cryopreserved pre-treatment testicular tissue represents a promising, yet experimental method of fertility preservation for prepubertal males facing sterilizing therapy. Healthcare providers should counsel families about the fertility risks of therapy, discuss or refer patients for standard fertility preservation options, and consider experimental approaches to fertility preservation while being mindful of the ethical questions these treatments raise.     

交界性卵巢肿瘤保留生育功能手术的临床研究

目的回顾性分析交界性卵巢肿瘤保留生育功能手术,比较腹腔镜手术与开腹手术对卵巢生育功能及疾病预后的影响。方法收集襄阳市中心医院2008年1月1日至2013年12月31日予保留生育功能手术治疗的交界性卵巢肿瘤患者52例,分为开腹组27例、腹腔镜组25例。比较两组患者手术前后月经及生育情况、术后复发情况。结果术后总妊娠率56.5%,腹腔镜组高于开腹组(70.8%vs.40.9%,P0.05);总体复发率9.6%,两组差异无统计学意义(P0.05)。但是与开腹手术组相比,腹腔镜组术中出血量少[(342.0±60.9)vs.(422.0±69.8)ml,P0.05)]、手术时间短[(222.0±11.9)vs.(245.9±12.8)min,P0.05]、术后胃肠道功能恢复快[(26.3±7.5)vs.(41.6±6.4)h,P0.05]、合并感染少(8.0%vs.29.6%,P0.05)、住院时间短[(7.2±0.5)vs.(7.9±1.0)d,P0.05]。结论在交界性卵巢肿瘤保留生育功能手术中,腹腔镜手术与传统开腹手术相比具有同样的有效性和安全性,但腹腔镜手术术中出血量及术后并发症少、住院时间短、术后患者恢复快,更重要的是能更好的保留交界性卵巢肿瘤患者的生育力。     

Scattered radiation to gonads: Role of testicular shielding for para-aortic and homolateral illiac nodal radiotherapy

BackgroundScattered radiation to organs at risk deserves great attention during radiotherapy especially when the concern is about fertility. Minimizing the delivery of scattered radiation to the gonads while treating abdominal nodes or pelvic fields in male patients requires adequate shielding of the testes to preserve testicular functions. We constructed a testicular shield with cerrobend for the purpose of treatment of seminoma of testis stage I and IIA disease.Materials & methodsAn outer shell of coconut of required dimensions was taken as a base over which cerrobend was poured to obtain two semi-spherical half testicular shields. Five patients of seminoma early stage (stage I and IIA) were treated with this testicular shield.ResultsThe estimated total dose received by the testis by scatter radiation after completion of the treatment was 0.115 Gy (0.28%) of total mid-plane dose of 40 Gy delivered by inverted Y field. At a distance of 8 cm from the inferior field border the 2 cm thick cerrobend testicular shield provided a shielding factor of 3.2/0.3 = 10.33.ConclusionsWith proper testicular shielding, doses as low as 0.28% of the prescribed dose can be achieved. This low dose is believed to maintain the fertility of the patient.