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논문KCI 등재

여성암 생존자에서의 가임력 보존

Fertility preservation in female cancer survivors

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초록

가임기 여성에서 암은 드물지 않게 발병하며 최근에는 암 치료방법의 발전으로 생존율이 현저히 증가하게 되었다. 또한 최근 들어 여성의 초 출산연령이 증가하는 경향을 보이고 있다. 이에 따라 여성 암 생존자에서의 가임력 보존은 보다 중요한 문제 로 대두되고 있다. 암 환자에서 항암화학요법의 종류와 용량, 암종의 종류, 치료 시작까지의 시간, 환자의 나이, 배우자의 유무 등이 다르기 때문에 각각의 환자는 개별화하여 평가되어야 하며, 서로 다른 가임력 보존의 전략이 필요하게 된다. 배우 자가 있거나 공여정자를 사용할 수 있고, 항암화학요법 또는 방사선치료 시작시기의 연기가 가능한 경우 임상적으로 확립된 가임력 보존의 방법인 배아 동결보존이 선택 가능하다. 난자의 동결보존은 배우자가 없을 경우 선택 가능하지만, 아직까지 임상적 경험이 부족한 단계이며 임신율도 낮은 상황이다. 최근 들어 인간에서 동결보존된 난소조직의 자가 이식 후 성공적 인 분만이 보고되었지만 이 방법은 아직까지 임상적 경험은 부족한 상태로 실험적인 단계에 머물고 있다. 따라서 최적의 동결-해동방법을 확립하고 해동후 생존율, 임신율, 출산율을 향상시키기 위한 추가적인 연구가 필요할 것으로 사료된다. 본 논문에서는 항암치료 후 가임력 소실의 기전과 현재까지 연구된 가임력 보존의 방법에 관하여 기술하고자 한다.

Abstract

Cancer is not rare in women in reproductive ages, and there has been a remarkable improvement in the survival rates due to progress in cancer treatment. Moreover, women have been delaying the initiation of childbearing to later in life. Thus the preservation of fertility in female cancer survivors has become an important health issue. Because of the variations in the type of cancer, type and dose of chemotherapy, the time available before onset of treatment, the patient’s age, and the status of partners, each case should be individualized and requires a different strategy in fertility preservation. When a partner or donor sperm is available, embryo cryopreservation is now an established and acceptable technique for fertility preservation, providing a delay in the initiation of chemotherapy or radiotherapy. Oocyte cryopreservation is available for women without partners, but there is a limited experience with this technique and pregnancy rate is still low. In spite of the recent reports of successful birth after autotransplantation of cryopreserved-thawed human ovarian tissue, clinical experience is also limited and this technique remains still experimental. Further researches for establishing optimal cryopreservation and thawing protocols and increasing post-thawing survival, pregnancy, and delivery rates are necessary. In this article, the mechanisms of reproductive failure after cancer therapy and the strategies for fertility preservation in cancer survivors are discussed.

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