Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California, USA.
Cancer (Impact Factor: 4.89). 04/2012; 118(7):1933-9. DOI: 10.1002/cncr.26403
Source: PubMed

ABSTRACT The authors sought to describe the age-specific impact of infertility and early menopause after chemotherapy among reproductive age women with cancer.
A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on reproductive health history. Five cancer types were included: leukemia, Hodgkin disease (HD), non-Hodgkin lymphoma (NHL), breast cancer, and gastrointestinal(GI) cancer. Survey questions addressed acute ovarian failure (cessation of menses after treatment), early menopause (menopause before 45 years old), and infertility (failed conception). Logistic regression was used to determine the proportions of acute ovarian failure and infertility based on age at diagnosis. Censored data methods were used to determine the probability of early menopause.
Six hundred twenty women received chemotherapy alone. The percentage reporting acute ovarian failure was 8%, 10%, 9%, and 5% for HD, NHL, breast cancer, and GI cancer, respectively. Acute ovarian failure increased significantly with age at diagnosis (P < .05). In subjects not reporting acute ovarian failure, the incidence of infertility was at least 40% at age 35 years and increased significantly with age at diagnosis in HD and breast cancer (P < .05). The estimated probability of early menopause was at least 25% at age 30 years and increased significantly with younger age at diagnosis in HD, NHL, and GI cancer (P < .05).
For patients to receive appropriate counseling, it is important that they understand the potential increased risk of infertility and early menopause beyond that of acute ovarian failure. These findings can provide improved, age-specific counseling regarding reproductive impairment for young women diagnosed with cancer.

Download full-text


Available from: Patricia P Katz, May 28, 2014
36 Reads
  • Source
    • "Infertility and early menopause are associated with chemotherapy even in women who resumed menses after treatment [56]. The probability of early menopause and infertility depends on the type of cancer, the treatment, and the age at diagnosis [56]. Relationships between post-chemotherapy AMH levels and ovarian function, as indicated by menstrual activity, are difficult to establish. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Anti-Mullerian hormone (AMH) is a very sensitive indicator of the ovarian follicular content. Chemotherapeutic agents are notoriously ovariotoxic in that they damage follicles. The aim of this systematic review was to investigate the interest of serum AMH variations in determining the acute and long-term effects of chemotherapy on the ovarian reserve. According to the PRISMA guidelines, searches were conducted on PubMed for all English language articles until December 2013. Fifteen articles that focused on dynamic variations of AMH levels before and after chemotherapy were selected. Cancer patients have significantly lower AMH after chemotherapy than age-matched controls. Longitudinal studies of AMH variations before, during and after chemotherapy provide information about the degree of follicle loss for each patient according to different chemotherapy regimens. Different patterns of AMH levels during the ovarian recovery phase make it possible to discriminate between high and low gonadotoxic chemotherapy protocols. In addition, pretreatment AMH levels are shown to predict the long-term ovarian function after the end of treatment. These results may help to better understand the ovarian toxicity mechanisms of chemotherapy and to predict the degree of the ovarian follicle loss. Therefore, it can be useful for fertility preservation strategies, fertility counseling and future family planning.
    Reproductive Biology and Endocrinology 03/2014; 12(1):26. DOI:10.1186/1477-7827-12-26 · 2.23 Impact Factor
  • Source
    • "Damage to theca and granulose cells from alkylating chemotherapeutic agents can prevent this maturation process and cause premature menopause (57). It is difficult to predict when POF will occur, as some reports have shown this immediately after administration of treatment, while others have reported a significant delay (15, 58). Endocrine function not only plays a role in maintaining ovarian function, but also in predicting it. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Reproductive health among cancer survivors is an important quality of life issue. Certain cancer therapies have known fertility risks. There is an existing cohort of adolescents and young adults (AYA) cancer survivors that, seen less frequently in clinical care settings than active patients, are likely not having discussions of fertility and other reproductive health issues. A survivor or healthcare provider can easily assume that the window of opportunity for fertility preservation has passed, however emerging research has shown this may not be the case. Recent data demonstrates a close relationship between fertility and other late effects to conclude that ongoing assessment during survivorship is warranted. Some fertility preservation procedures have also been shown to mitigate common late effects. This review explores the link between late effects from treatment and common comorbidities from infertility, which may exacerbate these late effects. This review also highlights the relevance of fertility discussions in the AYA survivorship population.
    Frontiers in Oncology 10/2013; 3:248. DOI:10.3389/fonc.2013.00248
  • Source
    • "Ainsi, pour les patientes qui n'auraient pu bé né ficier de pré servation de leur fertilité avant le traitement du cancer et qui ont eu la chance de ré cupé rer une fonction cyclé e, peut se poser la question de la congé lation ovocytaire « pré ventive » en vue d'un futur projet de grossesse. 2. Fertilité aprè s traitement gonadotoxique Letourneau et al. ont mené une vaste e ´ tude e ´ pidé miologique ré trospective incluant 1041 femmes a ˆgé es de 18 a ` 40 ans au moment du diagnostic de leucé mie, lymphome, cancer du sein ou tumeur gastro-intestinale [4]. L'incidence de l'insuffisance ovarienne pré maturé e, dé finie par les auteurs comme la persistance de l'amé norrhé e a ` plus de 12 mois post-chimiothé rapie, est a ` 10 % et s'avè re trè s fortement corré lé e a ` l'a ˆge. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The number of young cancer women theoretically eligible for fertility preservation before chemotherapy is steadily increasing. Nevertheless, the number of patients who can really benefit from complex ART techniques such as ovarian tissue or oocyte/embryo cryopreservation remains very low mainly because of a too short time-interval between the cancer diagnosis and its treatment. Lack of adequate information regarding post treatment infertility risk and logistical difficulties to access to a highly specialized cryopreservation centre are also reasons of importance. It is now well-established that these patients are at high risk of infertility even if they return to a normal ovarian function. Therefore, for patients who could not benefit from fertility preservation before cancer treatment, and who have recovered spontaneous menstrual cycle, one might raise the question of oocyte freezing once the cancer cured.
    Gynécologie Obstétrique & Fertilité 08/2013; · 0.52 Impact Factor
Show more