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Частота преждевременной недостаточности яичников и ранней менопаузы у носительниц патогенных вариантов BRCA1
Частота преждевременной недостаточности яичников и ранней менопаузы у носительниц патогенных вариантов BRCA1
Рштуни С.Д., Чернуха Г.Е., Донников А.Е., Табеева Г.И., Бурменская О.В., Марченко Л.А. Частота преждевременной недостаточности яичников и ранней менопаузы у носительниц патогенных вариантов BRCA1. Гинекология. 2022;24(5):374–379. DOI: 10.26442/20795696.2022.5.201688
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Выявление частоты встречаемости преждевременной недостаточности яичников (ПНЯ) и ранней менопаузы с учетом репродуктивного статуса у носительниц патогенного варианта гена BRCA1.
Материалы и методы. После соблюдения критериев включения и исключения из 90 пациенток – носительниц патогенных вариантов в гене BRCA1 основную группу составили 38 женщин, контрольную – 110 пациенток без указанных патогенных вариантов. В исследуемых группах оценивались репродуктивный статус и возраст наступления менопаузы, перенесенные оперативные вмешательства на органах малого таза и паллиативные методы лечения.
Результаты. Частота встречаемости ПНЯ в группе носительниц патогенных вариантов в гене BRCA1 статистически значимо выше в сравнении с контрольной группой (p<0,004), в то время как в частоте встречаемости ранней менопаузы статистически значимых различий в анализируемых группах не выявлено (13,2% против 4,5%; p<0,069). При анализе репродуктивного статуса статистически значимых различий также не выявлено.
Выводы. Носительницы патогенных вариантов в гене BRCA1 и без таковых не различались по основным показателям репродуктивного статуса. У носительниц патогенных вариантов гена BRCA1 частота встречаемости ПНЯ статистически значимо выше, чем в группе контроля. Нельзя исключить неблагоприятное влияние патогенных вариантов гена BRCA на овариальный резерв и репродуктивный потенциал женщин. Здоровым носителям патогенных вариантов в гене BRCA1/2 рекомендовано планирование беременности в раннем репродуктивном периоде.
Ключевые слова: BRCA1/2, гены репарации ДНК, гены-кандидаты, преждевременная недостаточность яичников, ранняя менопауза
Materials and methods. According to the inclusion and exclusion criteria, out of 90 carriers of pathogenic variants of the BRCA1 gene, 38 females were included in the study group, and 110 females without these pathogenic variants were included in the control group. The reproductive status, age of menopause onset, history of pelvic surgeries, and palliative care were evaluated in the study groups.
Results. The incidence of POF in the group of carriers of pathogenic variants of the BRCA1 gene was significantly higher compared to the control group (p<0.004), while the incidence of early menopause showed no significant differences in the studied groups (13.2% vs. 4.5%, respectively; p<0,069). No significant differences were found in the analysis of reproductive status.
Conclusions. Females with and without pathogenic variants of the BRCA1 gene did not differ significantly by the main indices of reproductive status. Carriers of pathogenic BRCA1 gene variants have a significantly higher incidence of POF vs. controls. Adverse effects of pathogenic BRCA gene variants on women's ovarian reserve and reproductive potential cannot be excluded. Healthy carriers of pathogenic variants of the BRCA1/2 gene are recommended to plan pregnancy in the early reproductive period.
Keywords: BRCA1/2, DNA repair genes, candidate genes, premature ovarian failure, early menopause
Материалы и методы. После соблюдения критериев включения и исключения из 90 пациенток – носительниц патогенных вариантов в гене BRCA1 основную группу составили 38 женщин, контрольную – 110 пациенток без указанных патогенных вариантов. В исследуемых группах оценивались репродуктивный статус и возраст наступления менопаузы, перенесенные оперативные вмешательства на органах малого таза и паллиативные методы лечения.
Результаты. Частота встречаемости ПНЯ в группе носительниц патогенных вариантов в гене BRCA1 статистически значимо выше в сравнении с контрольной группой (p<0,004), в то время как в частоте встречаемости ранней менопаузы статистически значимых различий в анализируемых группах не выявлено (13,2% против 4,5%; p<0,069). При анализе репродуктивного статуса статистически значимых различий также не выявлено.
Выводы. Носительницы патогенных вариантов в гене BRCA1 и без таковых не различались по основным показателям репродуктивного статуса. У носительниц патогенных вариантов гена BRCA1 частота встречаемости ПНЯ статистически значимо выше, чем в группе контроля. Нельзя исключить неблагоприятное влияние патогенных вариантов гена BRCA на овариальный резерв и репродуктивный потенциал женщин. Здоровым носителям патогенных вариантов в гене BRCA1/2 рекомендовано планирование беременности в раннем репродуктивном периоде.
Ключевые слова: BRCA1/2, гены репарации ДНК, гены-кандидаты, преждевременная недостаточность яичников, ранняя менопауза
________________________________________________
Materials and methods. According to the inclusion and exclusion criteria, out of 90 carriers of pathogenic variants of the BRCA1 gene, 38 females were included in the study group, and 110 females without these pathogenic variants were included in the control group. The reproductive status, age of menopause onset, history of pelvic surgeries, and palliative care were evaluated in the study groups.
Results. The incidence of POF in the group of carriers of pathogenic variants of the BRCA1 gene was significantly higher compared to the control group (p<0.004), while the incidence of early menopause showed no significant differences in the studied groups (13.2% vs. 4.5%, respectively; p<0,069). No significant differences were found in the analysis of reproductive status.
Conclusions. Females with and without pathogenic variants of the BRCA1 gene did not differ significantly by the main indices of reproductive status. Carriers of pathogenic BRCA1 gene variants have a significantly higher incidence of POF vs. controls. Adverse effects of pathogenic BRCA gene variants on women's ovarian reserve and reproductive potential cannot be excluded. Healthy carriers of pathogenic variants of the BRCA1/2 gene are recommended to plan pregnancy in the early reproductive period.
Keywords: BRCA1/2, DNA repair genes, candidate genes, premature ovarian failure, early menopause
Полный текст
Список литературы
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3. Golezar S, Ramezani Tehrani F, Khazaei S, et al. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric. 2019;22(4):403-11.
4. Менопауза и климактерическое состояние у женщины. Клинические рекомендации. 2021 г. [Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. 2021 g. (in Russian)].
5. Goswami D, Conway GS. Premature ovarian failure. Horm Res. 2007;68(4):196-202.
6. Roos WP, Kaina B. DNA damage-induced cell death by apoptosis. Trends Mol Med. 2006;12(9):440-50. DOI:10.1016/j.molmed.2006.07.007
7. Cohen IS, Bar C, Paz-Elizur T, et al. DNA lesion identity drives choice of damage tolerance pathway in murine cell chromosomes. Nucleic Acids Res. 2015;43(3):1637-45. DOI:10.1093/nar/gku1398
8. Stolz A, Ertych N, Kienitz A, et al. The CHK2-BRCA1 tumour suppressor pathway ensures chromosomal stability in human somatic cells. Nat Cell Biol. 2010;12:492-9.
9. Xiong B, Li S, Ai JS, et al. BRCA1 is required for meiotic spindle assembly and spindle assembly checkpoint activation in mouse oocytes. Biol Reprod. 2008;79:718-26.
10. Pal T, Keefe D, Sun P, Narod SA; the Hereditary Breast Cancer Clinical Study Group. Fertility in women with BRCA mutations: a case-control study. Fertil Steril. 2010;93(6):1805-8.
11. Oktay K, Kim JY, Barad D, Babayev SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol. 2010;28:240-4.
12. Derks-Smeets IAP, van Tilborg TC, van Montfoort A, et al. BRCA1 mutation carriers have a lower number of mature oocytes after ovarian stimulation for IVF/PGD. J Assist Reprod Genet. 2017;34:1475-82. DOI:10.1007/s10815-017-1014-3
13. Turan V, Bedoschi G, Emirdar V, et al. Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation. Cycle Outcomes Reprod Sci. 2018;25(1):26-32.
14. Shapira M, Raanani H, Feldman B, et al. BRCA mutation carriers show normal ovarian response in in vitro fertilization cycles. Fertil Steril. 2015;104(5):1162-7.
15. Gunnala V, Fields J, Irani M, et al. BRCA carriers have similar reproductive potential at baseline to noncarriers: comparisons in cancer and cancer-free cohorts undergoing fertility preservation. Fertil Steril. 2019;111:363-71. DOI:10.1016/j.fertnstert.2018.10.014
16. Lin W, Titus S, Moy F, et al. Ovarian Aging in Women With BRCA Germline Mutations. J Clin Endocrinol Metab. 2017;102(10):3839-47. DOI:10.1210/jc.2017-00765
17. Kępczyński Ł, Połatyńska K, Nykel A, et al. Age of natural menopause onset in BRCA1/2 carriers – systematic review and meta-analysis. Prz Menopauzalny. 2020;19(4):171-3. DOI:10.5114/pm.2020.101946
18. Schoenaker DA, Jackson CA, Rowlands JV, Mishra GD. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol. 2014;43(5):1542-62. DOI:10.1093/ije/dyu094
19. Finch A, Valentini A, Greenblatt E, et al. Frequency of premature menopause in women who carry a BRCA1 or BRCA2 mutation. Fertil Steril. 2013;99:1724-8.
20. Rzepka-Górska I, Tarnowski B, Chudecka-Głaz A, et al. Premature menopause in patients with BRCA1 gene mutation. Breast Cancer Res Treat. 2006;100: 59-63.
21. Lin WT, Beattie M, Chen LM, et al. Comparison of age at natural menopause in BRCA1/2 mutation carriers with a non-clinic-based sample of women in northern California. Cancer. 2013;119:1652-9.
22. Collins IM, Milne RL, McLachlan SA, et al. Do BRCA1 and BRCA2 mutation carriers have earlier natural menopause than their noncarrier relatives? Results from the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer. J Clin Oncol. 2013;31:3920-5.
23. van Tilborg TC, Broekmans FJ, Pijpe A, et al. Do BRCA1/2 mutation carriers have an earlier onset of natural menopause? Menopause. 2016;23:903-10.
24. Hofmann ER, Milstein S, Boulton SJ, et al. Caenorhabditis elegans HUS-1 is a DNA damage checkpoint protein required for genome stability and EGL-1-mediated apoptosis. Curr Biol. 2002;12:1908-18.
25. Уварова Е.В., Буралкина Н.А. Параметры овариального резерва девочек 15–17 лет с гармоничным половым и физическим развитием. Репродуктивное здоровье детей и подростков. 2010;3:20-8 [Uvarova EV, Buralkina NA. Parametry ovarial'nogo rezerva devochek 15–17 let s garmonichnym polovym i fizicheskim razvitiem. Reproduktivnoe zdorov'e detei i podrostkov. 2010;3:20-8 (in Russian)].
26. Buonomo B, Massarotti C, Dellino M, et al. Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting. BMC Med. 2021;19(1):205. DOI:10.1186/s12916-021-02081-7
2. Amenoreia i oligomenoreia. Klinicheskie rekomendatsii. 2021 g. (in Russian).
3. Golezar S, Ramezani Tehrani F, Khazaei S, et al. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric. 2019;22(4):403-11.
4. Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. 2021 g. (in Russian).
5. Goswami D, Conway GS. Premature ovarian failure. Horm Res. 2007;68(4):196-202.
6. Roos WP, Kaina B. DNA damage-induced cell death by apoptosis. Trends Mol Med. 2006;12(9):440-50. DOI:10.1016/j.molmed.2006.07.007
7. Cohen IS, Bar C, Paz-Elizur T, et al. DNA lesion identity drives choice of damage tolerance pathway in murine cell chromosomes. Nucleic Acids Res. 2015;43(3):1637-45. DOI:10.1093/nar/gku1398
8. Stolz A, Ertych N, Kienitz A, et al. The CHK2-BRCA1 tumour suppressor pathway ensures chromosomal stability in human somatic cells. Nat Cell Biol. 2010;12:492-9.
9. Xiong B, Li S, Ai JS, et al. BRCA1 is required for meiotic spindle assembly and spindle assembly checkpoint activation in mouse oocytes. Biol Reprod. 2008;79:718-26.
10. Pal T, Keefe D, Sun P, Narod SA; the Hereditary Breast Cancer Clinical Study Group. Fertility in women with BRCA mutations: a case-control study. Fertil Steril. 2010;93(6):1805-8.
11. Oktay K, Kim JY, Barad D, Babayev SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol. 2010;28:240-4.
12. Derks-Smeets IAP, van Tilborg TC, van Montfoort A, et al. BRCA1 mutation carriers have a lower number of mature oocytes after ovarian stimulation for IVF/PGD. J Assist Reprod Genet. 2017;34:1475-82. DOI:10.1007/s10815-017-1014-3
13. Turan V, Bedoschi G, Emirdar V, et al. Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation. Cycle Outcomes Reprod Sci. 2018;25(1):26-32.
14. Shapira M, Raanani H, Feldman B, et al. BRCA mutation carriers show normal ovarian response in in vitro fertilization cycles. Fertil Steril. 2015;104(5):1162-7.
15. Gunnala V, Fields J, Irani M, et al. BRCA carriers have similar reproductive potential at baseline to noncarriers: comparisons in cancer and cancer-free cohorts undergoing fertility preservation. Fertil Steril. 2019;111:363-71. DOI:10.1016/j.fertnstert.2018.10.014
16. Lin W, Titus S, Moy F, et al. Ovarian Aging in Women With BRCA Germline Mutations. J Clin Endocrinol Metab. 2017;102(10):3839-47. DOI:10.1210/jc.2017-00765
17. Kępczyński Ł, Połatyńska K, Nykel A, et al. Age of natural menopause onset in BRCA1/2 carriers – systematic review and meta-analysis. Prz Menopauzalny. 2020;19(4):171-3. DOI:10.5114/pm.2020.101946
18. Schoenaker DA, Jackson CA, Rowlands JV, Mishra GD. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol. 2014;43(5):1542-62. DOI:10.1093/ije/dyu094
19. Finch A, Valentini A, Greenblatt E, et al. Frequency of premature menopause in women who carry a BRCA1 or BRCA2 mutation. Fertil Steril. 2013;99:1724-8.
20. Rzepka-Górska I, Tarnowski B, Chudecka-Głaz A, et al. Premature menopause in patients with BRCA1 gene mutation. Breast Cancer Res Treat. 2006;100: 59-63.
21. Lin WT, Beattie M, Chen LM, et al. Comparison of age at natural menopause in BRCA1/2 mutation carriers with a non-clinic-based sample of women in northern California. Cancer. 2013;119:1652-9.
22. Collins IM, Milne RL, McLachlan SA, et al. Do BRCA1 and BRCA2 mutation carriers have earlier natural menopause than their noncarrier relatives? Results from the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer. J Clin Oncol. 2013;31:3920-5.
23. van Tilborg TC, Broekmans FJ, Pijpe A, et al. Do BRCA1/2 mutation carriers have an earlier onset of natural menopause? Menopause. 2016;23:903-10.
24. Hofmann ER, Milstein S, Boulton SJ, et al. Caenorhabditis elegans HUS-1 is a DNA damage checkpoint protein required for genome stability and EGL-1-mediated apoptosis. Curr Biol. 2002;12:1908-18.
25. Uvarova EV, Buralkina NA. Parametry ovarial'nogo rezerva devochek 15–17 let s garmonichnym polovym i fizicheskim razvitiem. Reproduktivnoe zdorov'e detei i podrostkov. 2010;3:20-8 (in Russian).
26. Buonomo B, Massarotti C, Dellino M, et al. Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting. BMC Med. 2021;19(1):205. DOI:10.1186/s12916-021-02081-7
2. Аменорея и олигоменорея. Клинические рекомендации. 2021 г. [Amenoreia i oligomenoreia. Klinicheskie rekomendatsii. 2021 g. (in Russian)].
3. Golezar S, Ramezani Tehrani F, Khazaei S, et al. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric. 2019;22(4):403-11.
4. Менопауза и климактерическое состояние у женщины. Клинические рекомендации. 2021 г. [Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. 2021 g. (in Russian)].
5. Goswami D, Conway GS. Premature ovarian failure. Horm Res. 2007;68(4):196-202.
6. Roos WP, Kaina B. DNA damage-induced cell death by apoptosis. Trends Mol Med. 2006;12(9):440-50. DOI:10.1016/j.molmed.2006.07.007
7. Cohen IS, Bar C, Paz-Elizur T, et al. DNA lesion identity drives choice of damage tolerance pathway in murine cell chromosomes. Nucleic Acids Res. 2015;43(3):1637-45. DOI:10.1093/nar/gku1398
8. Stolz A, Ertych N, Kienitz A, et al. The CHK2-BRCA1 tumour suppressor pathway ensures chromosomal stability in human somatic cells. Nat Cell Biol. 2010;12:492-9.
9. Xiong B, Li S, Ai JS, et al. BRCA1 is required for meiotic spindle assembly and spindle assembly checkpoint activation in mouse oocytes. Biol Reprod. 2008;79:718-26.
10. Pal T, Keefe D, Sun P, Narod SA; the Hereditary Breast Cancer Clinical Study Group. Fertility in women with BRCA mutations: a case-control study. Fertil Steril. 2010;93(6):1805-8.
11. Oktay K, Kim JY, Barad D, Babayev SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol. 2010;28:240-4.
12. Derks-Smeets IAP, van Tilborg TC, van Montfoort A, et al. BRCA1 mutation carriers have a lower number of mature oocytes after ovarian stimulation for IVF/PGD. J Assist Reprod Genet. 2017;34:1475-82. DOI:10.1007/s10815-017-1014-3
13. Turan V, Bedoschi G, Emirdar V, et al. Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation. Cycle Outcomes Reprod Sci. 2018;25(1):26-32.
14. Shapira M, Raanani H, Feldman B, et al. BRCA mutation carriers show normal ovarian response in in vitro fertilization cycles. Fertil Steril. 2015;104(5):1162-7.
15. Gunnala V, Fields J, Irani M, et al. BRCA carriers have similar reproductive potential at baseline to noncarriers: comparisons in cancer and cancer-free cohorts undergoing fertility preservation. Fertil Steril. 2019;111:363-71. DOI:10.1016/j.fertnstert.2018.10.014
16. Lin W, Titus S, Moy F, et al. Ovarian Aging in Women With BRCA Germline Mutations. J Clin Endocrinol Metab. 2017;102(10):3839-47. DOI:10.1210/jc.2017-00765
17. Kępczyński Ł, Połatyńska K, Nykel A, et al. Age of natural menopause onset in BRCA1/2 carriers – systematic review and meta-analysis. Prz Menopauzalny. 2020;19(4):171-3. DOI:10.5114/pm.2020.101946
18. Schoenaker DA, Jackson CA, Rowlands JV, Mishra GD. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol. 2014;43(5):1542-62. DOI:10.1093/ije/dyu094
19. Finch A, Valentini A, Greenblatt E, et al. Frequency of premature menopause in women who carry a BRCA1 or BRCA2 mutation. Fertil Steril. 2013;99:1724-8.
20. Rzepka-Górska I, Tarnowski B, Chudecka-Głaz A, et al. Premature menopause in patients with BRCA1 gene mutation. Breast Cancer Res Treat. 2006;100: 59-63.
21. Lin WT, Beattie M, Chen LM, et al. Comparison of age at natural menopause in BRCA1/2 mutation carriers with a non-clinic-based sample of women in northern California. Cancer. 2013;119:1652-9.
22. Collins IM, Milne RL, McLachlan SA, et al. Do BRCA1 and BRCA2 mutation carriers have earlier natural menopause than their noncarrier relatives? Results from the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer. J Clin Oncol. 2013;31:3920-5.
23. van Tilborg TC, Broekmans FJ, Pijpe A, et al. Do BRCA1/2 mutation carriers have an earlier onset of natural menopause? Menopause. 2016;23:903-10.
24. Hofmann ER, Milstein S, Boulton SJ, et al. Caenorhabditis elegans HUS-1 is a DNA damage checkpoint protein required for genome stability and EGL-1-mediated apoptosis. Curr Biol. 2002;12:1908-18.
25. Уварова Е.В., Буралкина Н.А. Параметры овариального резерва девочек 15–17 лет с гармоничным половым и физическим развитием. Репродуктивное здоровье детей и подростков. 2010;3:20-8 [Uvarova EV, Buralkina NA. Parametry ovarial'nogo rezerva devochek 15–17 let s garmonichnym polovym i fizicheskim razvitiem. Reproduktivnoe zdorov'e detei i podrostkov. 2010;3:20-8 (in Russian)].
26. Buonomo B, Massarotti C, Dellino M, et al. Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting. BMC Med. 2021;19(1):205. DOI:10.1186/s12916-021-02081-7
________________________________________________
2. Amenoreia i oligomenoreia. Klinicheskie rekomendatsii. 2021 g. (in Russian).
3. Golezar S, Ramezani Tehrani F, Khazaei S, et al. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric. 2019;22(4):403-11.
4. Menopauza i klimaktericheskoe sostoianie u zhenshchiny. Klinicheskie rekomendatsii. 2021 g. (in Russian).
5. Goswami D, Conway GS. Premature ovarian failure. Horm Res. 2007;68(4):196-202.
6. Roos WP, Kaina B. DNA damage-induced cell death by apoptosis. Trends Mol Med. 2006;12(9):440-50. DOI:10.1016/j.molmed.2006.07.007
7. Cohen IS, Bar C, Paz-Elizur T, et al. DNA lesion identity drives choice of damage tolerance pathway in murine cell chromosomes. Nucleic Acids Res. 2015;43(3):1637-45. DOI:10.1093/nar/gku1398
8. Stolz A, Ertych N, Kienitz A, et al. The CHK2-BRCA1 tumour suppressor pathway ensures chromosomal stability in human somatic cells. Nat Cell Biol. 2010;12:492-9.
9. Xiong B, Li S, Ai JS, et al. BRCA1 is required for meiotic spindle assembly and spindle assembly checkpoint activation in mouse oocytes. Biol Reprod. 2008;79:718-26.
10. Pal T, Keefe D, Sun P, Narod SA; the Hereditary Breast Cancer Clinical Study Group. Fertility in women with BRCA mutations: a case-control study. Fertil Steril. 2010;93(6):1805-8.
11. Oktay K, Kim JY, Barad D, Babayev SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol. 2010;28:240-4.
12. Derks-Smeets IAP, van Tilborg TC, van Montfoort A, et al. BRCA1 mutation carriers have a lower number of mature oocytes after ovarian stimulation for IVF/PGD. J Assist Reprod Genet. 2017;34:1475-82. DOI:10.1007/s10815-017-1014-3
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Авторы
С.Д. Рштуни*, Г.Е. Чернуха, А.Е. Донников, Г.И. Табеева, О.В. Бурменская, Л.А. Марченко
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия
*rshtunisandra@gmail.com
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*rshtunisandra@gmail.com
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия
*rshtunisandra@gmail.com
________________________________________________
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*rshtunisandra@gmail.com
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