臨床婦人科産科76巻4号

2022年04月発行

増刊号 最新の不妊診療がわかる！―生殖補助医療を中心とした新たな治療体系 第3章　生殖補助医療の調節卵巣刺激 卵巣刺激薬

ホルモン受容体陽性乳がん患者に対する妊孕性温存療法におけるアロマターゼ阻害薬を併用した調節卵巣刺激の意義

著者： 前沢忠志¹² 池田智明² 鈴木直¹

所属機関： ¹聖マリアンナ医科大学産婦人科学 ²三重大学医学部産科婦人科

ページ範囲：P.149 - P.154

▶ホルモン受容体陽性乳がん患者に対する調節卵巣刺激において，アロマターゼ阻害薬の使用はエストロゲンの上昇を抑制しながら多数の卵子を保存できる点において有用である．
▶妊孕性温存目的の調節卵巣刺激法として，注射製剤を用いた方法が選択されることが多いことから，アロマターゼ阻害薬の作用による卵巣過剰刺激症候群のリスク低減が期待できる．
▶アロマターゼ阻害薬の使用による体外受精後の妊娠・分娩，新生児の転帰は，自然周期やホルモン補充周期と比較しても遜色がない．
▶アロマターゼ阻害薬の使用による調節卵巣刺激後の乳がんの長期予後については不明である．

参考文献

1）Cakmak H, et al : Effective method for emergency fertility preservation : random-start controlled ovarian stimulation．Fertil Steril 100 : 1673-1680, 2013

2）Ubaldi FM, et al : Follicular versus luteal phase ovarian stimulation during the same menstrual cycle（DuoStim）in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate : new insight in ovarian reserve exploitation．Fertil Steril 105 : 1488-1495.e1, 2016

3）Reddy J, et al : Ovarian stimulation and fertility preservation with the use of aromatase inhibitors in women with breast cancer. Fertil Steril 98 : 1363-1369, 2012

4）Loubersac S, et al : Evolution of serum anti-Mullerian hormone（AMH）level in young women treated with chemotherapy for breast cancer according to basal AMH level．Eur J Obstet Gynecol Reprod Biol 254 : 132-137, 2020

5）Ravi R, et al : Amenorrhea After Chemotherapy In Breast Cancer Patient．J Ayub Med Coll Abbottabad 32 : 73-77, 2020

6）日本乳癌学会（編） ; 総説 初期治療．乳癌診療ガイドライン2018年版．金原出版，pp12-17，2018

7）Collaborative Group on Hormone Factors in Breast Cancer : Breast cancer and hormone replacement therapy : collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet 350 : 1047-1059, 1997

8）Venn A, et al : Risk of cancer after use of fertility drugs with in-vitro fertilisation. Lancet 354 : 1586-1590, 1999

9）Rodgers RJ, et al : The safety and efficacy of controlled ovarian hyperstimulation for fertility preservation in women with early breast cancer : a systematic review. Hum Reprod 32 : 1033-1045, 2017

10）Rodriguez-Wallberg KA, et al : Safety of fertility preservation in breast cancer patients in a register-based matched cohort study. Breast Cancer Res Treat 167 : 761-769, 2018

11）Germain D : Estrogen carcinogenesis in breast cancer. Endocrinol Metab Clin North Am 40 : 473-484, 2011

12）Quinn MM, et al : Response to ovarian stimulation is not impacted by a breast cancer diagnosis．Hum Reprod 32 : 568-574, 2017

13）Sonigo C, et al : Impact of letrozole supplementation during ovarian stimulation for fertility preservation in breast cancer patients. Eur J Obstet Gynecol Reprod Biol X 4 : 100049, 2019

14）Checa Vizcaino MA, et al : The effects of letrozole on ovarian stimulation for fertility preservation in cancer-affected women. Reprod Biomed Online 24 : 606-610, 2012

15）Johnson LN, et al : Response to ovarian stimulation in patients facing gonadotoxic therapy. Reprod Biomed Online 26 : 337-344, 2013

16）Domingo J, et al : Ovarian response to controlled ovarian hyperstimulation in cancer patients is diminished even before oncological treatment. Fertil Steril 97 : 930-934, 2012

17）Haas J, et al : Does daily co-administration of letrozole and gonadotropins during ovarian stimulation improve IVF outcome? Reprod Biol Endocrinol 15 : 70, 2017

18）Garcia-Velasco JA : The use of aromatase inhibitors in in vitro fertilization. Fertil Steril 98 : 1356-1358, 2012

19）村川晴生，他 : 低反応性難治性不妊症に対するアロマターゼ阻害剤（letrozole）を用いた排卵誘発法の検討．日受精着床会誌25 : 61-65, 2008

20）Practice Committees of American Society for Reproductive Medicine ; Society for Assissted Reproductive Technology : Mature oocyte cryopreservation : a guideline. Fertil Steril 99 : 37-43, 2013

21）Biljan MM, et al : The outcome of 150 babies following the treatment with letrozole or letrozole and gonadotropins.Fertil Steril 84（supp.1） : O-231.Abstract 1033, 2005

22）Akbari Sene, A., et al : Comparison of the pregnancy outcomes and the incidence of fetal congenital abnormalities in infertile women treated with letrozole and clomiphene citrate. J Obstet Gynaecol Res 44 : 1036-1041, 2018

23）Tulandi T, et al : Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate．Fertil Steril 85 : 1761-1765, 2006

24）Guang HJ, et al : Letrozole for patients with polycystic ovary syndrome : a retrospective study．Medicine（Baltimore）97 : e13038, 2018

25）Yun J, et al : Comparison of congenital malformations among babies born after administration of letrozole or clomiphene citrate for infertility treatment in a Korean cohort．Reprod Toxicol 82 : 88-93, 2018

26）日本生殖医学会（編・監修） : アロマターゼ阻害薬．生殖医療の必修知識2017．日本生殖学会，pp173-175, 2017

27）Practice Committee of the American Society for Reproductive Medicine, et al : Evidence-based treatments for couples with unexplained infertility : a guideline. Fertil Steril 113 : 305-322, 2020

28）Suzuki Ｎ : Clinical practice guidelines for fertility preservation in pediatric, adolescent, and young adults with cancer. Int J Clin Oncol 24 : 20-27, 2019