生育保护（FP）的适应症已经扩大。一些接受抗性损伤治疗的患者没有机会接受FP，引发了对这些患者可能发生早期卵巢功能不全的担忧。然而，FP在卵巢储备减少的女性中的有效性也受到质疑。孕酮前处方的卵巢刺激可以改善控制性卵巢刺激（COS）方案，但关于孕酮前进行卵巢刺激进行FP的疗效的数据有限。我们在2021年1月1日至2023年12月31日期间，在慶應義塾大学病院生殖单元进行了一项前瞻性研究，包括43名癌症或自身免疫性疾病的妇女先接受抗性损伤治疗后接受咨询。经过咨询后，我们获得了43名患者的FP知情同意书，其中优先考虑那些接受过抗性损伤治疗的基础疾病患者。在抗性损伤治疗之前或之后，使用促性腺激素释放激素类似物或孕酮来抑制黄体生成素进行COS。冷冻的成熟卵子数量是主要结果。该分析纳入了43名患者和67个辅助生殖技术周期。入组时的中位年龄为32（四分位范围29-37）岁。所有接受抗性损伤治疗的患者都有冷冻卵子。抗性损伤治疗导致较少的卵子（中位数3，四分位范围1-4；抗性损伤治疗前组：5名患者，13个周期）vs.中位数9（四分位范围5-14；抗性损伤治疗前组：38名患者，54个周期；P < 0.001）。尽管抗Müllerian激素水平在抗性损伤治疗后的组（n = 5，13个周期，中位数0.29，四分位范围0.15-1.04 pg/mL）低于抗性损伤治疗前组（n = 38，54个周期，中位数1.89，四分位范围1.15-4.08 pg/mL）（P = 0.004），但卵子成熟率在抗性损伤治疗后组 [中位数100（四分位范围77.5-100）％]比抗性损伤治疗前组 [中位数90.3（四分位范围75.0-100）％；P = 0.039]更高。抗性损伤治疗前组有5名患者解冻了他们冷冻的胚胎，其中3名患者生下了活婴。无论是在抗性损伤治疗后获得的卵子还是进行COS方案，从患有癌症或自身免疫疾病的妇女中获得的FP卵子质量都是令人满意的。©2023年。BioMed Central Ltd.，Springer Nature的一部分。

The indications for fertility preservation (FP) have expanded. A few patients who underwent gonadotoxic treatment did not have the opportunity to receive FP, leading to concerns that these patients may develop premature ovarian insufficiency. However, the usefulness of FP in women with reduced ovarian reserve has also been questioned. Progestin-primed ovarian stimulation can improve the controlled ovarian stimulation (COS) protocol, but there is limited data on the efficacy of FP with progestin-primed ovarian stimulation.We conducted a prospective study of 43 women with cancer or autoimmune diseases before and after gonadotoxic treatment at the reproductive unit of Keio University Hospital, counselled between 1 January 2018 and 31 December 2021. After counselling, informed consent was obtained for FP from 43 patients, with those who underwent gonadotoxic treatment of the primary disease being prioritised. Gonadotropin-releasing hormone analogue or progestin was used to suppress luteinising hormone in COS before or after gonadotoxic treatment. The number of cryopreserved mature oocytes was the primary outcome.Forty-three patients and 67 assisted reproductive technology cycles were included in the analysis. The median age at entry was 32 [inter quartile range (IQR), 29-37] years. All patients in the post-gonadotoxic treatment group had their oocytes frozen. Gonadotoxic treatment resulted in fewer oocytes [median 3 (IQR 1-4); pre-gonadotoxic treatment group: five patients, 13 cycles] vs. median 9 (IQR 5-14; pre-gonadotoxic treatment group: 38 patients, 54 cycles; P < 0.001). Although anti-Müllerian hormone levels were lower in the post-gonadotoxic treatment group (n = 5, 13 cycles, median 0.29 (IQR 0.15-1.04) pg/mL) than in the pre-gonadotoxic treatment group (n = 38, 54 cycles, median 1.89 (IQR 1.15-4.08) pg/mL) (P = 0.004), oocyte maturation rates were higher in the post-gonadotoxic treatment group [median 100 (IQR 77.5-100) %] than in the pre-gonadotoxic group [median 90.3 (IQR 75.0-100) %; P = 0.039]. Five patients in the pre-gonadotoxic treatment group had their cryopreserved embryos thawed, of which three had live births.Oocytes obtained for FP from women with cancer or autoimmune disease for FP are of satisfactory quality, regardless of whether they are obtained post-gonadotoxic treatment or COS protocols.© 2023. BioMed Central Ltd., part of Springer Nature.