臨床婦人科産科75巻1号

2021年01月発行

合併増大号　今月の臨床 生殖医療の基礎知識アップデート―患者説明に役立つ最新エビデンス・最新データ 一般不妊治療 特定の不妊原因に関する検査・治療

早発卵巣不全の治療

著者： 丸山哲夫¹

所属機関： ¹慶應義塾大学医学部産婦人科学教室

ページ範囲：P.76 - P.86

●早発卵巣不全では卵胞発育・排卵・妊娠・挙児の可能性はあるが，早発卵巣不全のサブタイプである早発閉経には，定義上その可能性はない．しかし，両者の鑑別は困難である．

●エビデンスのある早発卵巣不全の不妊治療は，現時点では卵子提供だけである．それ以外の早発卵巣不全の不妊治療は，いずれも十分なエビデンスはない．

●卵子提供以外の早発卵巣不全の不妊治療を行う際は，患者への十分な説明と情報共有を行うとともに，理解と同意を得たうえでの慎重な施行が求められる．

参考文献

1）Faddy MJ, et al : Accelerated disappearance of ovarian follicles in mid-life : implications for forecasting menopause. Hum Reprod 7 : 1342-1346, 1992

2）Gougeon A : Dynamics of follicular growth in the human : a model from preliminary results. Hum Reprod 1 : 81-87, 1986

3）van Kasteren YM, et al : Premature ovarian failure : a systematic review on therapeutic interventions to restore ovarian function and achieve pregnancy. Hum Reprod Update 5 : 483-492, 1999

4）Fraison E, et al : Pregnancy following diagnosis of premature ovarian insufficiency : a systematic review. Reprod Biomed Online 39 : 467-476, 2019

5）Maruyama T, et al : Achievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development : case reports. Endocr J 60 : 791-797, 2013

6）Miyazaki K, et al : Serum estradiol level during withdrawal bleeding as a predictive factor for intermittent ovarian function in women with primary ovarian insufficiency. Endocr J 62 : 93-99, 2015

7）Maruyama T : A woman with primary ovarian insufficiency had two live births resulting from intrauterine inseminations during 10 years of ovarian follicle monitoring. J Obstet Gynaecol Res 46 : 2159-2163, 2020

8）Ameratunga D, et al : In vitro fertilisation（IVF）with donor eggs in post-menopausal women : are there differences in pregnancy outcomes in women with premature ovarian failure（POF）compared with women with physiological age-related menopause? J Assist Reprod Genet 26 : 511-514, 2009

9）Savasi VM, et al : Maternal and fetal outcomes in oocyte donation pregnancies. Hum Reprod Update 22 : 620-633, 2016

10）Kawamura K, et al : Hippo signaling disruption and Akt stimulation of ovarian follicles for infertility treatment. Proc Natl Acad Sci U S A 110 : 17474-17479, 2013

11）Huhtaniemi I, et al : Advances in the Molecular Pathophysiology, Genetics, and Treatment of Primary Ovarian Insufficiency. Trends Endocrinol Metab 29 : 400-419, 2018

12）Check JH, et al : Ovulation induction and pregnancies in 100 consecutive women with hypergonadotropic amenorrhea. Fertil Steril 53 : 811-816, 1990

13）Ireland JJ, et al : Acute effects of estradiol and follicle-stimulating hormone on specific binding of human［125I］iodofollicle-stimulating hormone to rat ovarian granulosa cells in vivo and in vitro. Endocrinology 102 : 876-883, 1978

14）Britt KL, et al : Estrogen actions on follicle formation and early follicle development. Biol Reprod 71 : 1712-1723, 2004

15）Committee on Gynecologic P. Committee Opinion No. 698 : Hormone Therapy in Primary Ovarian Insufficiency. Obstet Gynecol 129 : e134-e141, 2017

16）Taylor AE, et al : A randomized, controlled trial of estradiol replacement therapy in women with hypergonadotropic amenorrhea. J Clin Endocrinol Metab 81 : 3615-3621, 1996

17）Tartagni M, et al : Effects of pretreatment with estrogens on ovarian stimulation with gonadotropins in women with premature ovarian failure : a randomized, placebo-controlled trial. Fertil Steril 87 : 858-861, 2007

18）Surrey ES, et al : The effect of gonadotropin suppression on the induction of ovulation in premature ovarian failure patients. Fertil Steril 52 : 36-41, 1989

19）Rosen GF, et al : Ovulation induction in women with premature ovarian failure : a prospective, crossover study. Fertil Steril 57 : 448-449, 1992

20）van Kasteren YM, et al : Ovulation induction in premature ovarian failure : a placebo-controlled randomized trial combining pituitary suppression with gonadotropin stimulation. Fertil Steril 64 : 273-278, 1995

21）Badawy A, et al : Induction of ovulation in idiopathic premature ovarian failure : a randomized double-blind trial. Reprod Biomed Online 15 : 215-219, 2007

22）Kawamura K, et al : Drug-free in-vitro activation of follicles for infertility treatment in poor ovarian response patients with decreased ovarian reserve. Reprod Biomed Online 40 : 245-253, 2020

23）Suzuki N, et al : Successful fertility preservation following ovarian tissue vitrification in patients with primary ovarian insufficiency. Hum Reprod 30 : 608-615, 2015

24）Chen X, et al : Retrospective analysis of reproductive outcomes in women with primary ovarian insufficiency showing intermittent follicular development. Reprod Biomed Online 32 : 427-433, 2016

25）Awwad JT, et al : An investigational ovarian stimulation protocol increased significantly the psychological burden in women with premature ovarian failure. Acta Obstet Gynecol Scand 91 : 1273-1278, 2012