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Master Thesis

Maladies auto-immunes et préservation de la fertilité des patientes de moins de 18 ans : évaluation en France en 2021

Abstract : Introduction: autoimmune diseases (AIDs) affect 3 to 5% of the population. In 8 out of 10 cases this concerns a woman of childbearing age. Premature ovarian failure (POI) before the age of 20 affects 1/10000. In 4 to 5%, the POI is of autoimmune origin. Objective: evaluate fertility preservation (FP) care for patients under 18 with AIDs in France in 2021 in order to offer consensual care as early as possible in their course. Methods: descriptive study using a questionnaire sent to reproductive physicians and internists caring for these patients. Results: the proportion of FPs under 18 with AIDs represents between 0 and 1% of total FP. 55% of centers have a specific route for these patients but only 45.5% of internists refer them and only if they are to receive gonadotoxic treatment with cyclophosphamide (CYC). The ovarian reserve (OR) assessment is not systematically carried out according to the centers and mainly includes the rate of AMH, FSH and AFC. 55.6% are performed upon diagnosis of MAI, otherwise from puberty or at the age of 15 years. OR is considered lowered from an AMH of 2 ng/mL and a AFC of 10. OR monitoring is not consensual and is mainly done if the patient has received treatment with CYC. The gonadotoxic dose of CYC is judged to be between 7 and 10g. The 2 main indications for FP are gonadotoxic treatment or reduced OR for age. Before puberty the chosen FP method is ovarian tissue cryopreservation (OTC). After puberty it is about oocyte vitrification (OV). Conclusion: in view of the heterogeneous responses from the centers, there is no standardized care pathway. For prepubertal patients we recommend an OTC only if a gonadotoxic dose treatment is to be administered. For pubertal patients, OV from 15 years of age in the event of lowered OR (AMH <1.1 ng/mL and/or CFA <8) or gonadotoxic treatment when the timeframe allows it. In some cases a CTO or MIV may be indicated. Our algorithms, however, need to be validated by prospective work.
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https://dumas.ccsd.cnrs.fr/dumas-03351888
Contributor : Médecine Ub Connect in order to contact the contributor
Submitted on : Wednesday, September 22, 2021 - 4:22:33 PM
Last modification on : Friday, October 22, 2021 - 3:44:42 AM

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Élisabeth Rault. Maladies auto-immunes et préservation de la fertilité des patientes de moins de 18 ans : évaluation en France en 2021. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03351888⟩

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