Impact of cancer therapies on ovarian reserve

Capsule:
Measures of ovarian reserve are impaired among cancer survivors compared with unexposed females of similar age. The degree of impairment is dependent on the toxicity of the previous treatment.

Authors:
Clarisa R. Gracia, M.D., M.S.C.E., Mary D. Sammel, Sc.D., Ellen Freeman, Ph.D., Maureen Prewitt, R.N., Claire Carlson, R.N., Anushree Ray, Ashley Vance, Jill P. Ginsberg, M.D.
Volume 97, Issue 1 , Pages 134-140.e1, January 2012

Objective:
To determine whether measures of ovarian reserve differ between females exposed to cancer therapies in a dose-dependent manner as compared with healthy controls of similar age and late reproductive age.

Design:
Cross-sectional analysis of data from a prospective cohort study.

Setting:
University medical center.

Patient(s):
Seventy-one cancer survivors aged 15–39 years; 67 healthy, similarly aged unexposed subjects; and 69 regularly menstruating women of late reproductive age (40–52 years).

Intervention(s):
None.

Main Outcome Measure(s):
Early follicular-phase hormones (FSH, E2, inhibin B, antimüllerian hormone [AMH]) and ovarian ultrasound measurements (ovarian volume and antral follicle counts [AFC]) were compared using multivariable linear regression.

Result(s):
In adjusted models, FSH, AMH, and AFC differed between exposed vs. unexposed subjects (FSH 11.12 mIU/mL vs. 7.25 mIU/mL; AMH 0.81 ng/mL vs. 2.85 ng/mL; AFC 14.55 vs. 27.20). In participants with an FSH

Conclusion(s):
Measures of ovarian reserve are impaired in a dose-dependent manner among cancer survivors compared with unexposed females of similar age. Reproductive hormone levels in menstruating survivors exposed to high-dose therapy are similar to those in late-reproductive-age women. The predictive value of measures for pregnancy and menopause must be studied.

ClinicalTrials.gov identifier:
NCT01143844.

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