Palabras clave
criopreservacion
tejido ovarico
maduracion in vitro
ovario artificial trasplantable
Cómo citar
Resumen
En las ultimas décadas, los avances en diagnóstico y tratamiento de enfermedades oncológicas han aumentado la supervivencia de los pacientes, generando como daño colateral altas tasas de insuficiencia ovárica prematura (IOP) e infertilidad, principalmente en pacientes jóvenes, debido a la gonadotoxicidad de la quimioterapia y la radioterapia. Este artículo revisa en primera instancia las distintas estrategias actuales de preservación de la fertilidad en este grupo de pacientes, como la criopreservación de embriones/ovocitos, que se presenta como opción convencional establecida, con altas tasas de éxito. Nuevos protocolos, como el inicio aleatorio de la estimulación ovárica, han mejorado la eficiencia y reducido el tiempo de espera para iniciar el tratamiento oncológico. La criopreservación y el trasplante de tejido ovárico (CTO/TTO) es la única opción válida para niñas prepuberales, y para casos urgentes. Estudios recientes muestran favorables tasas de éxito en la restauración endocrina y de la fertilidad, aunque todavia persisten preocupaciones sobre la reintroducción de células malignas. La maduración in vitro (MIV) de ovocitos ofrece una alternativa para pacientes con contraindicaciones para la estimulación ovárica controlada. Aunque la tasa de éxito ha mejorado, sigue siendo inferior a la de ovocitos maduros obtenidos mediante estimulación ovárica convencional. La revisión también plantea futuras estrategias de oncofertilidad que por el momento se encuentran en fase experimental, como el uso de nuevos agentes ferto-protectores durante la administración de quimioterapia, el cultivo de tejido ovárico para el desarrollo folicular in vitro y la aplicabilidad de ovarios artificiales trasplantables.
Citas
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