Fertilitenin Korunması
Özet
Gelişen kanser tedavileri sayesinde üreme çağındaki hastaların yaşam süreleri uzasa da kemoterapi ve radyoterapi gibi uygulamalar gonadal fonksiyonları bozarak infertiliteye yol açabilmektedir. Bu durum, çocuk ve adolesanlar dahil olmak üzere üreme çağındaki bireylerde fertilitenin korunmasını kritik bir hale getirmiştir. Geleneksel yaklaşımların aksine, günümüz tıp kılavuzları potansiyel gonadotoksik tedavi alacak hastaların süreç öncesinde üreme sağlığı uzmanlarına yönlendirilmesini ve bilgilendirilmesini güçlü şekilde tavsiye etmektedir. Kadınlarda en yaygın kullanılan fertilite koruma yöntemleri oosit, embriyo ve ovaryen doku kriyoprezervasyonu (OTC) olarak öne çıkmaktadır. Oosit ve embriyo dondurma süreçlerinde kontrollü ovaryen stimülasyon gerekirken, prepubertal hastalar için altın standart olan OTC yöntemi herhangi bir hormonal stimülasyon veya kanser tedavisinde gecikme gerektirmez. Ayrıca, radyoterapi alacak hastalarda overleri ışınlama alanından uzaklaştıran over transpozisyonu cerrahisi ile jinekolojik malignitelerde (serviks, endometrium ve over kanseri) uygulanan fertilite koruyucu sınırlı cerrahi müdahaleler de mevcuttur. Son yıllarda kök hücre terapileri ve in vitro maturasyon (IVM) gibi deneysel ve yenilikçi stratejiler de gelişim göstermektedir. Sonuç olarak, hastanın yaşına, evliliğine ve tedavi aciliyetine göre belirlenecek en uygun yöntemin onkoloji, üreme sağlığı ve psikiyatri gibi farklı disiplinlerden oluşan multidisipliner bir ekip tarafından koordine edilmesi gerekmektedir.
Although advanced cancer treatments have extended the survival rates of patients in their reproductive age, applications such as chemotherapy and radiotherapy can impair gonadal functions and lead to infertility. This situation has made fertility preservation critical for individuals in their reproductive years, including children and adolescents. Contrary to traditional approaches, current medical guidelines strongly recommend that patients who will receive potentially gonadotoxic treatments should be referred to reproductive health specialists and informed before the process begins. The most common fertility preservation methods used in women include oocyte, embryo, and ovarian tissue cryopreservation (OTC). While controlled ovarian stimulation is required for oocyte and embryo freezing, the OTC method, which is the gold standard for prepubertal patients, does not require any hormonal stimulation or delay in cancer treatment. Additionally, ovarian transposition surgery, which moves the ovaries away from the radiation zone in patients undergoing radiotherapy, and limited fertility-sparing surgical interventions in gynecological malignancies (cervical, endometrial, and ovarian cancers) are also available. In recent years, experimental and innovative strategies such as stem cell therapies and in vitro maturation (IVM) have also been developing. Consequently, the most appropriate method to be determined based on the patient's age, marital status, and treatment urgency must be coordinated by a multidisciplinary team consisting of specialists from different fields such as oncology, reproductive health, and psychiatry.
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