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Łubik-Lejawka D, Gabriel I, Marzec A, Olejek A. Oncofertility as an Essential Part of Comprehensive Cancer Treatment in Patients of Reproductive Age, Adolescents and Children. Cancers (Basel) 2024; 16:1858. [PMID: 38791937 PMCID: PMC11119835 DOI: 10.3390/cancers16101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
The number of children, adolescents and young adults diagnosed with cancer has been rising recently. Various oncological treatments have a detrimental effect on female fertility, and childbearing becomes a major issue during surveillance after recovery. This review discusses the impact of oncological treatments on the ovarian reserve with a thorough explanation of oncologic treatments' effects and modes of oncofertility procedures. The aim of this review is to help clinicians in making an informed decision about post-treatment fertility in their patients. Ultimately, it may lead to improved overall long-term outcomes among young populations suffering from cancer.
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Affiliation(s)
| | | | | | - Anita Olejek
- Department of Gynaecology, Obstetrics and Oncological Gynaecology in Bytom, Medical University of Silesia, 40-055 Katowice, Poland; (D.Ł.-L.); (I.G.); (A.M.)
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Lee SJ, Cha CD, Hong H, Choi YY, Chung MS. Adverse effects of tamoxifen treatment on bone mineral density in premenopausal patients with breast cancer: a systematic review and meta-analysis. Breast Cancer 2024:10.1007/s12282-024-01586-2. [PMID: 38671211 DOI: 10.1007/s12282-024-01586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND It is well known that adjuvant tamoxifen treatment for breast cancer in postmenopausal women decreased bone loss. However, the effects of adjuvant tamoxifen therapy on bone mineral density (BMD) in premenopausal patients with breast cancer remains uncertain. Tamoxifen would have a potential impact of premenopausal BMD on health. The aim of this meta-analysis was to assess this in premenopausal women with primary breast cancer. METHODS Through April 2020, studies reporting BMD changes of lumbar spine or hip in premenopausal women with primary breast cancer treated with adjuvant tamoxifen and tamoxifen plus chemotherapy or ovarian function suppression (OFS) were collected from EMBASE and PubMed. The meta-analysis was performed using random effects model of the standardized mean difference (SMD) of BMD in patients. RESULTS A total of 1432 premenopausal patients were enrolled in eight studies, involving 198 patients treated with tamoxifen alone in three studies. After a 3-year median follow-up, adjuvant tamoxifen decreased the lumbar spinal and hip BMD by as much as an SMD of -1.17 [95% confidence interval (CI); -1.58 to -0.76)] and -0.66 (95% CI, -1.55 to 0.23), respectively. In subgroup analysis in patients treated adjuvant tamoxifen and tamoxifen plus chemotherapy or OFS according to follow-up duration, the bone change of < 3 years follow-up group was -0.03 SMD (95% CI, -0.47 to 0.41) and that of ≥ 3 years follow-up group was -1.06 SMD (95% CI, -1.48 to -0.64). Compared with patients who received tamoxifen alone, patients who received combination therapy with chemotherapy or OFS showed lesser bone loss at the lumbar spine. CONCLUSIONS Our meta-analysis demonstrated that adjuvant tamoxifen therapy in premenopausal patients caused bone loss after 3 years of follow-up, especially at the lumbar spines. For a definite evaluation of the adverse effects of tamoxifen on bone, it is necessary to accumulate more relevant studies.
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Affiliation(s)
- Soo Jin Lee
- Department of Nuclear Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea
| | - Chihwan David Cha
- Department of Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea
| | - Hanpyo Hong
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea
| | - Min Sung Chung
- Department of Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, South Korea.
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Omranipour R, Ahmadi-Harchegani F, Saberi A, Moini A, Shiri M, Jalaeefar A, Arian A, Seifollahi A, Madani M, Eslami B, Alipour S. A New Model Including AMH Cut-off Levels to Predict Post-treatment Ovarian Function in Early Breast Cancer: A Prospective Cohort Study. ARCHIVES OF IRANIAN MEDICINE 2024; 27:96-104. [PMID: 38619033 PMCID: PMC11017260 DOI: 10.34172/aim.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/24/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND Breast cancer (BC) treatment decreases fertility capacity, but unnecessary fertility preservation procedures in women who would not be infertile after treatment would be a waste of time and resources and could cause the unwarranted exposure of cancer cells to exogenous sex hormones. It has been largely shown that post-treatment ovarian reserve is directly associated with pre-treatment anti-mullerian hormone levels (AMH0). A threshold for AMH0, or a model including AMH0 and patient characteristics that could distinguish the patients who will be infertile after treatments, still needs to be defined. Accordingly, this study was performed to specifically target this high-priority concern. METHODS Women≤45 years old with newly diagnosed non-metastatic BC were entered in this multicenter prospective cohort study. AMH0 and two-year post-treatment AMH (AMH2) were measured, and hormonal patient features were recorded as well. Receiver operating characteristic (ROC) curve analysis, decision tree (DT), and random forest analyses were performed to find a cut-off point for AMH0 and define a model involving related features for the prediction of AMH2. RESULTS The data from 84 patients were analyzed. ROC curve analysis revealed that AMH0>3 ng/mL (Area under the curve=0.69, 95% CI: 0.54‒0.84) was the best indicator for predicting AMH2≥0.7 (sensitivity=79%, specificity=60%). The best model detected by DT and random forest for predicting an AMH2>0.7 with a probability of 93% consisted of a combination of AMH0>3.3, menarche age<14, and age<31. CONCLUSION This combination model can be used to withhold fertility preservation procedures in BC patients. Performing larger studies is suggested to further test this model.
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Affiliation(s)
- Ramesh Omranipour
- Breast Diseases Research Center (BDRC), Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Oncologic Surgery, Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran
| | | | - Azin Saberi
- Department of Surgery, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Breast Diseases Research Center (BDRC), Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infertility, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mostafa Shiri
- Faculty of Mathematical Sciences, Shahid Beheshti University, Tehran, Iran
| | - Amirmohsen Jalaeefar
- Department of Oncologic Surgery, Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arvin Arian
- Department of Radiology, Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Akram Seifollahi
- Department of Pathology, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshad Madani
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Eslami
- Breast Diseases Research Center (BDRC), Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Alipour
- Breast Diseases Research Center (BDRC), Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Surgery, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Rives N, Courbière B, Almont T, Kassab D, Berger C, Grynberg M, Papaxanthos A, Decanter C, Elefant E, Dhedin N, Barraud-Lange V, Béranger MC, Demoor-Goldschmidt C, Frédérique N, Bergère M, Gabrel L, Duperray M, Vermel C, Hoog-Labouret N, Pibarot M, Provansal M, Quéro L, Lejeune H, Methorst C, Saias J, Véronique-Baudin J, Giscard d'Estaing S, Farsi F, Poirot C, Huyghe É. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines. Eur J Cancer 2022; 173:146-166. [PMID: 35932626 DOI: 10.1016/j.ejca.2022.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM To provide practice guidelines about fertility preservation (FP) in oncology. METHODS We selected 400 articles after a PubMed review of the literature (1987-2019). RECOMMENDATIONS Any child, adolescent and adult of reproductive age should be informed about the risk of treatment gonadotoxicity. In women, systematically proposed FP counselling between 15 and 38 years of age in case of treatment including bifunctional alkylating agents, above 6 g/m2 cyclophosphamide equivalent dose (CED), and for radiation doses on the ovaries ≥3 Gy. For postmenarchal patients, oocyte cryopreservation after ovarian stimulation is the first-line FP technique. Ovarian tissue cryopreservation should be discussed as a first-line approach in case of treatment with a high gonadotoxic risk, when chemotherapy has already started and in urgent cases. Ovarian transposition is to be discussed prior to pelvic radiotherapy involving a high risk of premature ovarian failure. For prepubertal girls, ovarian tissue cryopreservation should be proposed in the case of treatment with a high gonadotoxic risk. In pubertal males, sperm cryopreservation must be systematically offered to any male who is to undergo cancer treatment, regardless of toxicity. Testicular tissue cryopreservation must be proposed in males unable to cryopreserve sperm who are to undergo a treatment with intermediate or severe risk of gonadotoxicity. In prepubertal boys, testicular tissue preservation is: - recommended for chemotherapy with a CED ≥7500 mg/m2 or radiotherapy ≥3 Gy on both testicles. - proposed for chemotherapy with a CED ≥5.000 mg/m2 or radiotherapy ≥2 Gy. If several possible strategies, the ultimate choice is made by the patient.
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Affiliation(s)
- Nathalie Rives
- Normandie Univ, UNIROUEN, Team "Adrenal and Gonadal Physiopathology" Inserm U1239 Nordic, Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Blandine Courbière
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Thierry Almont
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Diana Kassab
- Methodology Unit, Association Française d'Urologie, Paris, Ile-de-France, France
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital of Saint-Etienne, Hospital, Nord Saint-Etienne cedex 02, France 42055; Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, 15 rue Ambroise Paré, Saint-Etienne cedex 02, France 42023
| | - Michaël Grynberg
- Reproductive Medicine and Fertility Department, Hôpital Antoine-Beclère, Clamart, Île-de-France, France
| | - Aline Papaxanthos
- Reproductive Medicine and Biology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Christine Decanter
- Medically Assisted Procreation and Fertility Preservation Department, Centre Hospitalier Régional Universitaire de Lille, Lille, Hauts-de-France, France
| | - Elisabeth Elefant
- Reference Center for Teratogenic Agents, Hôpital Armand-Trousseau Centre de Référence sur les Agents Tératogènes, Paris, Île-de-France, France
| | - Nathalie Dhedin
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Virginie Barraud-Lange
- Reproductive Medicine and Biology Department, Hôpital Cochin, Paris, Île-de-France, France
| | | | | | - Nicollet Frédérique
- Information and Promotion Department, Association Laurette Fugain, Paris, France
| | - Marianne Bergère
- Human Reproduction, Embryology and Genetics Directorate, Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Lydie Gabrel
- Good Practices Unit - Guidelines and Medicines Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Marianne Duperray
- Guidelines and Drug Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Christine Vermel
- Expertise Quality and Compliance Mission - Communication and Information Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Natalie Hoog-Labouret
- Research and Innovation, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Michèle Pibarot
- OncoPaca-Corse Regional Cancer Network, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Magali Provansal
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Quéro
- Cancerology and Radiotherapy Department, Hôpital Saint Louis, AP-HP, Paris, France
| | - Hervé Lejeune
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Charlotte Methorst
- Reproductive Medicine and Biology Department, Centre Hospitalier des Quatre Villes - Site de Saint-Cloud, Saint-Cloud, France
| | - Jacqueline Saias
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jacqueline Véronique-Baudin
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Sandrine Giscard d'Estaing
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadila Farsi
- Regional Cancer Network, Réseau Espace Santé Cancer, Lyon, Rhône-Alpes, France
| | - Catherine Poirot
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Éric Huyghe
- Urology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, Université Toulouse 3 Paul Sabatier, Toulouse, France.
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Diagnostic and predictive accuracy of anti-mullerian hormone for ovarian function after chemotherapy in premenopausal women with early breast cancer. Breast Cancer Res Treat 2022; 192:273-282. [PMID: 34997365 PMCID: PMC8927041 DOI: 10.1007/s10549-021-06508-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Accurate diagnosis and prediction of loss of ovarian function after chemotherapy for premenopausal women with early breast cancer (eBC) is important for future fertility and clinical decisions regarding the need for subsequent adjuvant ovarian suppression. We have investigated the value of anti-mullerian hormone (AMH) as serum biomarker for this. METHODS AMH was measured in serial blood samples from 206 premenopausal women aged 40-45 years with eBC, before and at intervals after chemotherapy. The diagnostic accuracy of AMH for loss of ovarian function at 30 months after chemotherapy and the predictive value for that of AMH measurement at 6 months were analysed. RESULTS Undetectable AMH showed a high diagnostic accuracy for absent ovarian function at 30 months with AUROC 0.89 (96% CI 0.84-0.94, P < 0.0001). PPV of undetectable AMH at 6 months for a menopausal estradiol level at 30 months was 0.77. In multivariate analysis age, pre-treatment AMH and FSH, and taxane treatment were significant predictors, and combined with AMH at 6 months, gave AUROC of 0.90 (95% CI 0.86-0.94), with PPV 0.79 for loss of ovarian function at 30 months. Validation by random forest models with 30% data retained gave similar results. CONCLUSIONS AMH is a reliable diagnostic test for lack of ovarian function after chemotherapy in women aged 40-45 with eBC. Early analysis of AMH after chemotherapy allows identification of women who will not recover ovarian function with good accuracy. These analyses will help inform treatment decisions regarding adjuvant endocrine therapy in women who were premenopausal before starting chemotherapy.
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Anderson RA, Cameron D, Clatot F, Demeestere I, Lambertini M, Nelson SM, Peccatori F. Anti-Müllerian hormone as a marker of ovarian reserve and premature ovarian insufficiency in children and women with cancer: a systematic review. Hum Reprod Update 2022; 28:417-434. [PMID: 35199161 PMCID: PMC9071067 DOI: 10.1093/humupd/dmac004] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/18/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Female patients undergoing anticancer treatment are at elevated risk of adverse ovarian outcomes including infertility and premature ovarian insufficiency (POI), which is associated with short- and long-term health risks. Anti-Müllerian hormone (AMH) is a key biomarker of ovarian reserve, but its role prior to and after cancer treatment is less well understood. OBJECTIVE AND RATIONALE To conduct a systematic review evaluating AMH as a biomarker of ovarian reserve and POI before and after anticancer treatment, which has become a pressing clinical issue in reproductive medicine. There are a large number of observational studies, but differences in patient groups, cancer diagnoses and study design make this a confusing field that will benefit from a thorough and robust review. SEARCH METHODS A systematic literature search for AMH in women with cancer was conducted in PubMed, Embase and Cochrane Central Register of Controlled Trials up to 1 April 2021. Bias review was conducted using the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) protocol along with qualitative assessment of quality. Exploratory subgroups were established based on age, cancer type and length of follow-up. OUTCOMES Ninety-two publications (N = 9183 patients) were included in this analysis after quality and bias review. Reduced/undetectable AMH was consistently identified in 69/75 studies (92%) following chemotherapy or radiotherapy, with reductions ranging from 42% to concentrations below the limit of detection, and many reporting mean or median declines of ≥90%. Where longitudinal data were analysed (42 studies), a majority (33/42 (79%)) of studies reported at least partial recovery of AMH at follow-up, however, effect estimates were highly variable, reflecting that AMH levels were strongly impacted by anticancer treatment (i.e. the chemotherapy regimen used and the number of treatment cycles need), with recovery and its degree determined by treatment regimen, age and pre-treatment AMH level. In 16/31 (52%) publications, oligo/amenorrhoea was associated with lower post-treatment AMH consistent with impending POI, although menstruation and/or pregnancy were reported in patients with low or undetectable AMH. Long-term (>5 years) follow-up of paediatric patients following cancer treatment also found significantly lower AMH compared with control groups in 14/20 (70%) of studies, with very variable effect sizes from complete loss of AMH to full recovery depending on treatment exposure, as in adult patients. WIDER IMPLICATIONS AMH can be used to identify the damaging effect of cancer treatments on ovarian function. This can be applied to individual women, including pre-pubertal and adolescent girls, as well as comparing different treatment regimens, ages and pre-treatment AMH levels in populations of women. While there was evidence for its value in the diagnosis of POI after cancer treatment, further studies across a range of diagnoses/treatment regimens and patient ages are required to clarify this, and to quantify its predictive value. A major limitation for the use of AMH clinically is the very limited data relating post-treatment AMH levels to fertility, duration of reproductive lifespan or time to POI; analysis of these clinically relevant outcomes will be important in further research.
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Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK,Correspondence address. MRC Centre for Reproductive Health, The Queen’s Medical Research Institute, Edinburgh BioQuarter, 47 Little France Crescent, Edinburgh EH16 4TJ, UK. Tel: +44-(0)-131-242-6386; E-mail:https://orcid.org/0000-0002-7495-518X
| | - David Cameron
- Edinburgh University Cancer Centre, IGMM, Edinburgh, UK
| | | | - Isabelle Demeestere
- Fertility clinic, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matteo Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy,Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK,NIHR Bristol Biomedical Research Centre, Bristol, UK,The Fertility Partnership, Oxford, UK
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Zhou B, Kwan B, Desai MJ, Nalawade V, Ruddy KJ, Nathan PC, Henk HJ, Murphy JD, Whitcomb BW, Su HI. Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors. Fertil Steril 2022; 117:1047-1056. [PMID: 35216831 PMCID: PMC9081208 DOI: 10.1016/j.fertnstert.2022.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data. DESIGN In a cross-sectional design, AMH levels in patients who developed incident breast cancer between ages 15-39 years during 2005-2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups. SETTING Commercially insured females in the United States. PATIENT(S) Females with and without breast cancer. EXPOSURE(S) Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy. MAIN OUTCOME MEASURE(S) AMH levels. RESULT(S) A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0-6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2-4 years, and then by a plateau over 1-2 years before a decline was observed. CONCLUSION(S) In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan.
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Affiliation(s)
- Beth Zhou
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, California
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, California; Moores Cancer Center, University of California, San Diego, California
| | - Milli J Desai
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, California
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | | | - Paul C Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Brian W Whitcomb
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, California; Moores Cancer Center, University of California, San Diego, California.
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8
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Mailliez A, Pigny P, Bogart E, Keller L, D'orazio E, Vanseymortier M, le Deley MC, Decanter C. Is ovarian recovery after chemotherapy in young patients with early breast cancer influenced by controlled ovarian hyperstimulation for fertility preservation or tumor characteristics? Results of a prospective study in 126 patients. Int J Cancer 2022; 150:1850-1860. [PMID: 35038360 DOI: 10.1002/ijc.33933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/29/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022]
Abstract
Young individuals, aged <40 years, represent 7% of all patients with early breast cancer (EBC), most of whom receive chemotherapy. Preserving future fertility in these patients has become a major concern. This prospective study assessed ovarian function during and after chemotherapy according to patient and tumor characteristics and evaluated the outcome of controlled ovarian hyperstimulation (COH). Ovarian reserve was evaluated in terms of amenorrhea duration and by longitudinal serum anti-Müllerian hormone (AMH) level variations measured at study entry, during treatment, and until 24 months thereafter. COH has been proposed for patients receiving adjuvant chemotherapy. We studied the association between clinical factors and ovarian function using Cox models and logistic regression. In this young population (age <38 years, median=32), 85 of 90 evaluable patients (94%) experienced chemo-induced amenorrhea, including six persistent amenorrhea and one chemotherapy-induced definitive ovarian failure. Overall, 33% of patients still had undetectable AMH values 12 months after the end of chemotherapy, although most had recovered spontaneous and regular menstrual function. No specific factor was associated with clinical or biological late ovarian dysfunction, except for age and baseline AMH value. Overall, 58 patients underwent COH. The mean number of total retrieved oocytes and metaphase II oocytes were of 11.7 and 6.9, respectively. Thus, our study confirms the importance of fertility preservation in young patients with EBC. Our findings indicates that sequential chemotherapy is associated with a higher risk of persistent amenorrhea. There was no significant association between tumor characteristics, fertility preservation, or recovery of ovarian reserve. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Audrey Mailliez
- Breast Cancer Unit, Medical Oncology Department, Oscar Lambret Center, Lille, France
| | - Pascal Pigny
- Laboratoire de Biochimie « Hormonologie, Métabolisme-Nutrition & Oncologie » Centre de Biologie Pathologie, Centre Hospitalier Régional Universitaire, Lille, France.,INSERM UMR-S1277 CANTHER, Université de Lille, Lille, France
| | - Emilie Bogart
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Laura Keller
- Institut de Biologie de la Reproduction-Spermiologie-CECOS, hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Emmanuelle D'orazio
- Centre d'Assistance médicale à la Procréation et de Préservation de la Fertilité, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marie Vanseymortier
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | | | - Christine Decanter
- Centre d'Assistance médicale à la Procréation et de Préservation de la Fertilité, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France.,EA 4308 Gamétogénèse et qualité du gamète, Centre Hospitalier Universitaire de Lille, Lille, France
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9
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Ozcan MCH, Snegovskikh V, Adamson GD. Oocyte and embryo cryopreservation before gonadotoxic treatments: Principles of safe ovarian stimulation, a systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221074886. [PMID: 35130799 PMCID: PMC8829712 DOI: 10.1177/17455065221074886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Review the safety of fertility preservation through ovarian stimulation with oocyte or embryo cryopreservation, including cycle and medication options. EVIDENCE REVIEW A systematic review of peer-reviewed sources revealed 2 applicable randomized control trials and 60 cohort studies as well as 20 additional expert opinions or reviews. RESULTS The capacity for future family building is important for the majority of reproductive age people, despite life-altering medical or oncologic diagnosis. Modern fertility preservation generates a high rate of oocyte yield while utilizing protocols that can be started at multiple points in the menstrual cycle and suppressing supra-physiologic levels of estrogen. Finally, more than one quarter of fertility preservation patients will return to later utilize fertility services. CONCLUSION For most patients, fertility preservation can safely be pursued and completed within 2 weeks without affecting disease severity or long-term survival.
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Affiliation(s)
- Meghan CH Ozcan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
- Meghan CH Ozcan, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 90 Plain St., Providence, RI 02903, USA.
| | - Victoria Snegovskikh
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
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10
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Feng J, Ma WW, Li HX, Pei XY, Deng SL, Jia H, Ma WZ. Melatonin prevents cyclophosphamide-induced primordial follicle loss by inhibiting ovarian granulosa cell apoptosis and maintaining AMH expression. Front Endocrinol (Lausanne) 2022; 13:895095. [PMID: 35992124 PMCID: PMC9381702 DOI: 10.3389/fendo.2022.895095] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Cyclophosphaty -45mide (Cyc) chemotherapy in young female cancer patients is associated with an increased risk of premature ovarian insufficiency (POI). This study was designed to investigate the protective role of melatonin (Mel) as an adjuvant against Cyc-induced POI. Female mice received a single intraperitoneal (i.p.) dose of Cyc (75 mg/kg). Mel protection was achieved in mice after i.p. injection of melatonin (50 mg/kg) every 24 h for four consecutive days prior to chemotherapy initiation and for 14 additional days. Ovarian reserve testing, hormonal assays for follicle-stimulating hormone, luteinizing hormone, and anti-Müllerian hormone (AMH), assessment of the oxidative stress status, and measurement of the relative expression of genes in PTEN/AKT/FOXO3a and mitochondrial apoptosis pathways were performed. The results showed that treatment with 50 mg/kg Mel significantly prevented Cyc-induced over-activation of primordial follicles by maintaining the plasma level of AMH and subsequently preventing litter size reduction in mice treated with Cyc chemotherapy. Importantly, Mel treatment significantly prevented ovarian granulosa cell loss by inhibiting the mitochondrial apoptotic pathway. Identifying the protective actions of Mel against Cyc-induced primordial follicle loss has important implications for fertility maintenance in young cancer patients undergoing chemotherapy.
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Affiliation(s)
- Juan Feng
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, and Key Laboratory of Reproduction and Genetics of Ningxia Hui Autonomous Region, School of Basic Medical Science, Ningxia Medical University, Yinchuan, China
| | - Wen-Wen Ma
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, and Key Laboratory of Reproduction and Genetics of Ningxia Hui Autonomous Region, School of Basic Medical Science, Ningxia Medical University, Yinchuan, China
| | - Hui-Xia Li
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, and Key Laboratory of Reproduction and Genetics of Ningxia Hui Autonomous Region, School of Basic Medical Science, Ningxia Medical University, Yinchuan, China
| | - Xiu-Ying Pei
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, and Key Laboratory of Reproduction and Genetics of Ningxia Hui Autonomous Region, School of Basic Medical Science, Ningxia Medical University, Yinchuan, China
| | - Shou-Long Deng
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- *Correspondence: Shou-Long Deng, ; Hua Jia, ; Wen-Zhi Ma,
| | - Hua Jia
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, and Key Laboratory of Reproduction and Genetics of Ningxia Hui Autonomous Region, School of Basic Medical Science, Ningxia Medical University, Yinchuan, China
- *Correspondence: Shou-Long Deng, ; Hua Jia, ; Wen-Zhi Ma,
| | - Wen-Zhi Ma
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, and Key Laboratory of Reproduction and Genetics of Ningxia Hui Autonomous Region, School of Basic Medical Science, Ningxia Medical University, Yinchuan, China
- *Correspondence: Shou-Long Deng, ; Hua Jia, ; Wen-Zhi Ma,
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11
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Nouri N, Aghebati-Maleki L, Yousefi M. Adipose-Derived Mesenchymal Stem Cells: A Promising Tool in the Treatment of pre mature ovarian failure. J Reprod Immunol 2021; 147:103363. [PMID: 34450435 DOI: 10.1016/j.jri.2021.103363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/03/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022]
Abstract
Despite being rare, primary ovarian insufficiency (POI) is a significant cause of infertility and deficiency of ovarian hormone in women. Several health risks are also associated with POI, which include dry eye syndrome, reduced density of bones and enhanced fracture risks, troublesome menopausal symptoms, early development of cardiovascular disease, and psychological effects such as declined cognition, reduced perceived psychological support, anxiety, and depression. Replacing premenopausal levels of ovarian sex steroids through proper hormone replacement therapy could improve the quality of life for POI women and ameliorate related health risks. Herein, POI and its complications, in addition to hormone replacement therapies, which are safe and effective, are discussed. It is proposed that the use of HRT) Hormone replacement therapy (formulations which mimic normal production of ovarian hormones could reduce POI-associated morbidity rates if they are continued by the age 50, which is approximately the natural age of menopause. Particular populations of POI women are also addressed, which include those with enhanced risk of ovarian or breast cancer, those with Turner syndrome, those approaching natural menopause, and those who are breastfeeding. It is generally predicted that stem cell-based therapies would be both safe and effective. In fact, several types of cells have been described as safe, though their effectiveness and therapeutic application are yet to be defined. Several factors exist which could affect the results of treatment, such as cell handling, ex-vivo preparation strategies, variations in tissue of origin, potency, and immunocompatibility. Accordingly, cell types potentially effective in regenerative medicine could be recognized. Notably, products of MSCs from various sources of tissues show different levels of regenerative capabilities. The ultimate focus of the review is on adipose tissue-derive MCSs (ADMSCs), which possess exceptional features such as general availability, great ability to proliferate and differentiate, immunomodulatory capabilities, and low immunogenicity.
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Affiliation(s)
- Narges Nouri
- Student's Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Aghebati-Maleki
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehdi Yousefi
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Stem Cell Research Center, Tabriz University of Medical Science, Tabriz, Iran.
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12
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Song Y, Liu H. A review on the relationship between anti-mullerian hormone and fertility in treating young breast cancer patients. BMC WOMENS HEALTH 2021; 21:295. [PMID: 34376160 PMCID: PMC8353739 DOI: 10.1186/s12905-021-01420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
Despite the fact that the long-term survival rate of breast cancer patients had been significantly improved owing to the systemic breast cancer therapies, there are still some side effects such as amenorrhea and fertility retention to be resolved, leaving it an important thing to understand the possible side effects on fertility and fertility preservation strategies while undergoing breast cancer treatment, due to the fact that most young patients hope to become pregnant and have children after breast cancer treatment. With anti-müllerian hormone (AMH) being the most sensitive marker for predicting ovarian function in young premenopausal women with breast cancer, this review is aimed to provide the additional guidance for clinical application of AMH by exploring the impacts of AMH on the fertility of young breast cancer patients, the relationship between AMH and metabolism, and the relationship between BRAC gene mutation and fertility protection strategies.
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Affiliation(s)
- Yixuan Song
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hong Liu
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
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13
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Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis. J Pers Med 2021; 11:jpm11080704. [PMID: 34442350 PMCID: PMC8400427 DOI: 10.3390/jpm11080704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. METHODS A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger's and Begg's tests were used to assess the risk of publication bias. RESULTS Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of -1.97 (95% CI: -3.12, -0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. CONCLUSIONS Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.
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Kim S, Kim SW, Han SJ, Lee S, Park HT, Song JY, Kim T. Molecular Mechanism and Prevention Strategy of Chemotherapy- and Radiotherapy-Induced Ovarian Damage. Int J Mol Sci 2021; 22:ijms22147484. [PMID: 34299104 PMCID: PMC8305189 DOI: 10.3390/ijms22147484] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Fertility preservation is an emerging discipline, which is of substantial clinical value in the care of young patients with cancer. Chemotherapy and radiation may induce ovarian damage in prepubertal girls and young women. Although many studies have explored the mechanisms implicated in ovarian toxicity during cancer treatment, its molecular pathophysiology is not fully understood. Chemotherapy may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions. Oxidative stress and the radiosensitivity of oocytes are the main causes of gonadal damage after radiation treatment. Fertility preservation options can be differentiated by patient age, desire for conception, treatment regimen, socioeconomic status, and treatment duration. This review will help highlight the importance of multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.
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Affiliation(s)
- Seongmin Kim
- Gynecologic Cancer Center, CHA Ilsan Medical Center, CHA University College of Medicine, 1205 Jungang-ro, Ilsandong-gu, Goyang-si 10414, Korea;
| | - Sung-Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-W.K.); (S.-J.H.)
| | - Soo-Jin Han
- Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-W.K.); (S.-J.H.)
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
- Correspondence: ; Tel.: +82-2-920-6773
| | - Hyun-Tae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Jae-Yun Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
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15
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Demeestere I, Racape J, Dechene J, Dupuis J, Morschhauser F, De Wilde V, Lazarovici J, Ghesquieres H, Touati M, Sibon D, Alexis M, Gac AC, Moatti H, Virelizier E, Maisonneuve H, Pranger D, Houot R, Fornecker LM, Tempescul A, André M, Casasnovas RO. Gonadal Function Recovery in Patients With Advanced Hodgkin Lymphoma Treated With a PET-Adapted Regimen: Prospective Analysis of a Randomized Phase III Trial (AHL2011). J Clin Oncol 2021; 39:3251-3260. [PMID: 34156881 DOI: 10.1200/jco.21.00068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The prospective, randomized AHL2011 trial demonstrated that the use of the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen (ABVD) after two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated) in early responders on the basis of a positron emission tomography (PET)-driven strategy was safe and minimized toxicity compared with standard 6 BEACOPPescalated cycles. This substudy investigated the benefit of this strategy in gonadal function and fertility in patients under 45 years old. METHODS Ovarian function was assessed by serum measurement of follicle-stimulating hormone (FSH), estradiol, and anti-müllerian hormone in women, and semen analysis, FSH, and testosterone levels were used to evaluate testicular function in men at baseline, end of treatment, and during 5 years of follow-up. RESULTS A total of 145 women and 424 men, enrolled between May 19, 2011, and April 29, 2014, were included. The risk of premature ovarian insufficiency (FSH > 24 IU/L) and of having a low ovarian reserve (anti-müllerian hormone < 0.5 ng/mL) was reduced after treatment in the PET-driven group (odds ratio [OR], 0.20; 95% CI, 0.08 to 0.50; P = .001 and OR, 0.15; 95% CI, 0.04 to 0.56, P = .005, respectively). Both parameters were correlated with age and dose of alkylating agents. However, no significant differences were observed in terms of pregnancy rates. Men in the PET-driven group had a higher recovery rate of sperm parameters after treatment compared with the standard BEACOPPescalated group, as well as a lower risk of severe testicular damage (OR, 0.26; 95% CI, 0.13 to 0.5; P < .0001) and a higher likelihood of achieving pregnancy (OR, 3.7; 95% CI, 1.4 to 9.3; P = .004). CONCLUSION Although both treatments affected ovarian reserve and spermatogenesis, the PET-driven strategy decreased the risk of gonadal dysfunction and infertility in advanced Hodgkin lymphoma.
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Affiliation(s)
- Isabelle Demeestere
- Research Laboratory on Human Reproduction and Fertility Clinic, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Judith Racape
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, and Biomedical Research Department, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Dechene
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - Jehan Dupuis
- Department of Haematology, Hopital H. Mondor, Creteil, France
| | - Franck Morschhauser
- Department of Hematology, University of Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Virginie De Wilde
- Department of Haematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julien Lazarovici
- Department of Haematology Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Hervé Ghesquieres
- Department of Haematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, et Université Claude Bernard Lyon-1, Pierre Bénite, France
| | | | - David Sibon
- Department of Haematology, Hopital Necker, Paris, France
| | - Magda Alexis
- Department of Haematology, CH Orleans, Orleans, France
| | - Anne-Claire Gac
- Department of Haematology, Institut d'hématologie de basse normandie, Caen, France
| | - Hannah Moatti
- Department of Haematology, APHP, Hopital Saint Louis, Paris, France
| | | | - Hervé Maisonneuve
- Department of Haematology, Hopital departemental de Vendée, La Roche sur Yon, France
| | - Delphine Pranger
- Department of Haematology, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Roch Houot
- Department of Hematology, University Hospital of Rennes, Rennes, France
| | | | - Adrian Tempescul
- Department of Hematology, University Hospital of Brest, Brest, France
| | - Marc André
- Department of Haematology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - René-Olivier Casasnovas
- Department of Haematology, University Hospital F Mitterrand and Inserm UMR1231, Dijon, France
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Martelli V, Latocca MM, Ruelle T, Perachino M, Arecco L, Beshiri K, Razeti MG, Tagliamento M, Cosso M, Fregatti P, Lambertini M. Comparing the Gonadotoxicity of Multiple Breast Cancer Regimens: Important Understanding for Managing Breast Cancer in Pre-Menopausal Women. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:341-351. [PMID: 34079366 PMCID: PMC8164347 DOI: 10.2147/bctt.s274283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
Over the last several decades, improvements in breast cancer treatment have contributed to increased cure rates for women diagnosed with this malignancy. Consequently, great importance should be paid to the long-term side effects of systemic therapies. For young women (defined as per guideline ≤40 years at diagnosis) who undergo chemotherapy, one of the most impactful side effects on their quality of life is premature ovarian insufficiency (POI) leading to fertility-related problems and the side effects of early menopause. Regimens, type, and doses of chemotherapy, as well as the age of patients and their ovarian reserve at the time of treatment are major risk factors for treatment-induced POI. For these reasons, childbearing desire and preservation of ovarian function and/or fertility should be discussed with all premenopausal patients before planning the treatments. This manuscript summarizes the available fertility preservation techniques in breast cancer patients, the risk of treatment-induced POI with different anticancer treatments, and the possible procedures to prevent it. A special focus is paid to the role of oncofertility counseling, as a central part of the visit in this setting, during which the patient should receive all the information about the potential consequences of the disease and of the proposed treatment on her future life.
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Affiliation(s)
- Valentino Martelli
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Maria Maddalena Latocca
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Tommaso Ruelle
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marta Perachino
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Luca Arecco
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Kristi Beshiri
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Maria Grazia Razeti
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marco Tagliamento
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Maurizio Cosso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- U.O.C. Clinica Di Chirurgia Senologica, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Diagnostic Surgical Sciences, School of Medicine, University of Genova, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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Fertility and Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00405-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Xu H, Zhang M, Zhang H, Alpadi K, Wang L, Li R, Qiao J. Clinical Applications of Serum Anti-Müllerian Hormone Measurements in Both Males and Females: An Update. Innovation (N Y) 2021; 2:100091. [PMID: 34557745 PMCID: PMC8454570 DOI: 10.1016/j.xinn.2021.100091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/03/2021] [Indexed: 12/17/2022] Open
Abstract
Infertility is one of the most common non-communicable diseases, affecting both men and women equally. Ovarian reserve, the number of primordial follicles in the ovaries is believed to be the most important determinants for female fertility. Anti-Müllerian hormone (AMH) secreted from granulosa cells of growing follicles is recognized as the most important biomarker for ovarian reserve. Ovarian reserve models have been developed using AMH and other hormonal indicators, thus childbearing plans and reproductive choices could be arranged by women. In assisted reproductive technology cycles, measurement of AMH helps to predict ovarian response and guide recombinant follicle-stimulating hormone dosing in women. Serum AMH level is increasingly being recognized as a potential surrogate marker for polycystic ovarian morphology, one of the criteria for diagnosis of polycystic ovarian syndrome. AMH is also secreted by Sertoli cells of testes in men, and AMH measurements in the prediction of surgical sperm recovery rate in men have also been investigated. AMH levels are significantly higher in boys than in girls before puberty. Therefore, serum levels of AMH in combination with testosterone is used for the differential diagnosis of disorders of sex development, anorchia, non-obstructive azoospermia, and persistent Müllerian duct syndrome. Recently, serum AMH measurements have also been used in fertility preservation programs in oncofertility, screening for granulosa cell tumors, and prediction of menopause applications. In this review, we will focus on clinical application of AMH in fertility assessments for healthy men and women, as well as for cancer patients. Anti-Müllerian hormone (AMH) plays a key role in models assessing ovarian reserve AMH is used for the differential diagnosis of disorders of sex development AMH provides a molecular marker for related fertility and infertility disorders An international standard will aid in the development of various AMH assays
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Affiliation(s)
- Huiyu Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Mengqian Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | | | - Lina Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
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19
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Cancer survivorship: Reproductive health outcomes should be included in standard toxicity assessments. Eur J Cancer 2021; 144:310-316. [DOI: 10.1016/j.ejca.2020.11.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
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20
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Nelson SM, Anderson RA. Prediction of premature ovarian insufficiency: foolish fallacy or feasible foresight? Climacteric 2021; 24:438-443. [PMID: 33522318 DOI: 10.1080/13697137.2020.1868426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prediction of premature ovarian insufficiency (POI) would be of substantial individual benefit, but being a heterogeneous and fluctuating condition, with an extensive range of complex etiologies and arbitrary diagnostic criteria, might make this seem foolhardy. However, contemporary and complementary genetic strategies assessing consanguineous and large POI pedigrees and cohorts with age at natural menopause have shown strong enrichment in genes regulating DNA damage repair, homologous recombination, and meiosis, processes that are critical to oogenesis and folliculogenesis. Recognition of the molecular architecture of POI and its contribution to baseline genotypic risk may enable these estimates to be refined further by estimation of the residual ovarian reserve. Increasing data derived from spontaneous and gonadotoxic-induced POI cohorts demonstrate the utility of anti-Müllerian hormone (AMH) to predict POI. This review presents current understanding of how genetics in combination with AMH may facilitate the prediction of POI.
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Affiliation(s)
- S M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK.,NIHR Bristol Biomedical Research Centre, Bristol, UK.,The Fertility Partnership, London, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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21
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Hopeman MM, Cameron KE, Prewitt M, Barnhart K, Ginsberg JP, Sammel MD, Gracia CR. A predictive model for chemotherapy-related diminished ovarian reserve in reproductive-age women. Fertil Steril 2021; 115:431-437. [PMID: 33455812 DOI: 10.1016/j.fertnstert.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To develop and internally validate a clinical predictive tool to assess the likelihood that a young cancer patient will experience diminished ovarian reserve (DOR) after chemotherapy. DESIGN Prospective cohort study. SETTING University hospitals. PATIENT(S) Postpubertal adolescent and young adult women with a new diagnosis of cancer requiring chemotherapy. INTERVENTION None. MAIN OUTCOME MEASURE(S) Diminished ovarian reserve after completion of and recovery from chemotherapy, defined as serum antimüllerian hormone (AMH) <1 ng/mL at 8-24 months after completion of chemotherapy. RESULT(S) A multivariable logistic regression model which includes age, cancer type, exposure to an alkylating agent, and baseline AMH value accurately predicts the diagnosis of DOR after chemotherapy with an area under the receiver operating characteristic curve of 0.89. CONCLUSION(S) Pretreatment information on age, cancer type, use of an alkylating agent, and baseline AMH levels make up a clinically useful predictive tool to identify which women are most at risk for DOR caused by chemotherapy.
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Affiliation(s)
- Margaret M Hopeman
- Division of Reproductive Endocrinology and Infertility, Philadelphia, Pennsylvania.
| | - Katherine E Cameron
- Division of Reproductive Endocrinology and Infertility, Philadelphia, Pennsylvania
| | - Maureen Prewitt
- Division of Reproductive Endocrinology and Infertility, Philadelphia, Pennsylvania
| | - Kurt Barnhart
- Division of Reproductive Endocrinology and Infertility, Philadelphia, Pennsylvania
| | - Jill P Ginsberg
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary D Sammel
- Division of Reproductive Endocrinology and Infertility, Philadelphia, Pennsylvania
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology and Infertility, Philadelphia, Pennsylvania
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22
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Jin Z, Griffith MA, Rosenthal AC. Identifying and Meeting the Needs of Adolescents and Young Adults with Cancer. Curr Oncol Rep 2021; 23:17. [PMID: 33449203 DOI: 10.1007/s11912-020-01011-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Adolescents and young adults (AYAs) with cancer are a vulnerable population with unique needs that are under-recognized and often overlooked by healthcare providers. This review focuses on identifying and meeting some of those needs including adherence to treatment, financial implications, impact on fertility and intimacy, issues with work/school, isolation, challenges with re-entry, and long-term side effects and survivorship. RECENT FINDINGS Survival rates have not improved in adolescents and young adults with cancer at the same rate as in children and older adults (the so called "AYA gap"). Restricted or delayed access to care and inconsistent cancer treatment and follow-up care contribute to this. Importantly, fertility preservation options have broadened and efforts to provide age appropriate counseling prior to treatment have improved. Additionally, AYAs face a variety of psychosocial issues while dealing with a cancer diagnosis during critical developmental years, and yet data pertaining to the successful identification and management of these issues is lacking. As a result, there has been recent increasing awareness that this patient population warrants strong advocates, additional research, and requires age group specific resources to be successful in navigating their cancer experience during treatment and into survivorship care. Members of the healthcare team should familiarize themselves with the unique needs of AYA cancer patients to provide optimal patient care. In order to build upon early progress, this group calls for additional study particularly when it comes to barriers to enrollment for AYA-specific research (including clinical trials), recognizing psychosocial needs (both during and after treatment), transition planning for returning to life after cancer, and managing long-term effects of treatment (including neuro cognitive changes). In addition, access to financial resources and appropriate mental health support needs to be improved.
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Affiliation(s)
- Zhaohui Jin
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Melody A Griffith
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, 85054, USA
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23
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Anderson RA, Nelson SM. Anti-Müllerian Hormone in the Diagnosis and Prediction of Premature Ovarian Insufficiency. Semin Reprod Med 2021; 38:263-269. [PMID: 33429444 DOI: 10.1055/s-0040-1722319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The menopause and its pathological version, premature ovarian insufficiency (POI), are characterized by the cessation of follicle growth in the ovary, with consequent lack of estrogen production and amenorrhea. The measurement of a specific product of ovarian follicles would therefore be expected to be a valuable biomarker in women with POI, and to be of likely clinical value in the diagnosis and perhaps prediction of POI. Anti-Müllerian hormone (AMH) is produced by the granulosa cells of growing follicles and is therefore likely to be of value in this context. Current data indicate that measurement of AMH is an accurate indicator of POI in many situations and has diagnostic validity and may facilitate more timely diagnosis. AMH seems to be of limited value in predicting age at natural menopause, even with multiple measurements, and there are scarce data regarding prediction of POI, other than when it is imminent, and in some contexts where there is an immediate iatrogenic threat to ovarian function. AMH therefore appears to have considerable value as a diagnostic test for POI, but apart from highlighting broadly those at increased risk, it has inadequate precision to be able to predict accurately the timing of onset of impending POI.
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Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, United Kingdom.,NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
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24
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Anderson RA, Amant F, Braat D, D'Angelo A, Chuva de Sousa Lopes SM, Demeestere I, Dwek S, Frith L, Lambertini M, Maslin C, Moura-Ramos M, Nogueira D, Rodriguez-Wallberg K, Vermeulen N. ESHRE guideline: female fertility preservation. Hum Reprod Open 2020; 2020:hoaa052. [PMID: 33225079 PMCID: PMC7666361 DOI: 10.1093/hropen/hoaa052] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/02/2020] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION What is the recommended management for women and transgender men with regards to fertility preservation (FP), based on the best available evidence in the literature? SUMMARY ANSWER The ESHRE Guideline on Female Fertility Preservation makes 78 recommendations on organization of care, information provision and support, pre-FP assessment, FP interventions and after treatment care. Ongoing developments in FP are also discussed. WHAT IS KNOWN ALREADY The field of FP has grown hugely in the last two decades, driven by the increasing recognition of the importance of potential loss of fertility as a significant effect of the treatment of cancer and other serious diseases, and the development of the enabling technologies of oocyte vitrification and ovarian tissue cryopreservation (OTC) for subsequent autografting. This has led to the widespread, though uneven, provision of FP for young women. STUDY DESIGN SIZE DURATION The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 November 2019 and written in English were included in the review. PARTICIPANTS/MATERIALS SETTING METHODS Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help providers meet a growing demand for FP options by diverse groups of patients, including those diagnosed with cancer undergoing gonadotoxic treatments, with benign diseases undergoing gonadotoxic treatments or those with a genetic condition predisposing to premature ovarian insufficiency, transgender men (assigned female at birth), and women requesting oocyte cryopreservation for age-related fertility loss.The guideline makes 78 recommendations on information provision and support, pre-FP assessment, FP interventions and after treatment care, including 50 evidence-based recommendations-of which 31 were formulated as strong recommendations and 19 as weak-25 good practice points and 3 research only recommendations. Of the evidence-based recommendations, 1 was supported by high-quality evidence, 3 by moderate-quality evidence, 17 by low-quality evidence and 29 by very low-quality evidence. To support future research in the field of female FP, a list of research recommendations is provided. LIMITATIONS REASONS FOR CAUTION Most interventions included are not well studied in FP patients. As some interventions, e.g. oocyte and embryo cryopreservation, are well established for treatment of infertility, technical aspects, feasibility and outcomes can be extrapolated. For other interventions, such as OTC and IVM, more evidence is required, specifically pregnancy outcomes after applying these techniques for FP patients. Such future studies may require the current recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in female FP, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in FP. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. R.A.A. reports personal fees and non-financial support from Roche Diagnostics, personal fees from Ferring Pharmaceuticals, IBSA and Merck Serono, outside the submitted work; D.B. reports grants from Merck Serono and Goodlife, outside the submitted work; I.D. reports consulting fees from Roche and speaker's fees from Novartis; M.L. reports personal fees from Roche, Novartis, Pfizer, Lilly, Takeda, and Theramex, outside the submitted work. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.) †ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Frédéric Amant
- Department of Gynaecological Oncology, Academic Medical Centres Amsterdam, Amsterdam, The Netherlands.,Department of Gynaecology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oncology, Catholic University Leuven, Leuven, Belgium
| | - Didi Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Arianna D'Angelo
- Wales Fertility Institute, Swansea Bay Health Board, University Hospital of Wales, Cardiff University, Cardiff, UK
| | | | - Isabelle Demeestere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Lucy Frith
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | | | - Mariana Moura-Ramos
- Reprodutive Medicine Unit, Unit of Clinical Psychology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Coimbra, Portugal
| | - Daniela Nogueira
- Laboratory of Reproductive Biology, INOVIE Fertilité Clinique Croix du Sud, Toulouse, France
| | - Kenny Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Division of Gynaecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
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25
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Abstract
The 5 principal reasons a patient may consider fertility preservation are: treatment for cancer that may affect fertility, treatment for nonmalignant medical conditions that may affect fertility, planned indications, planned gender-affirming hormone therapy or surgery, or in the setting of genetic conditions that may increase the risks of premature ovarian insufficiency or early menopause. This paper will focus on describing who may consider preserving their fertility, how to provide the best clinical evaluation of those seeking fertility preservation, and current and future fertility preservation techniques. Last, we will highlight a need to continue to expand access to fertility preservation technologies.
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26
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Risk of chemotherapy-related amenorrhoea (CRA) in premenopausal women undergoing chemotherapy for early stage breast cancer. Breast Cancer Res Treat 2020; 186:237-245. [PMID: 33047206 PMCID: PMC7940159 DOI: 10.1007/s10549-020-05951-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/23/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE While chemotherapy has improved survival among younger women with breast cancer, it can induce temporary or permanent chemotherapy-related amenorrhoea (CRA), impacting survival benefit, quality of life and, importantly for younger patients, fertility. METHODS This single institution retrospective study of 107 premenopausal women with early stage breast cancer who received neoadjuvant or adjuvant combined chemotherapy treatment investigates the association of clinicopathological factors (including age-related, gynaecological and tumour-related variables) with CRA and resumption of menses using generalised linear models for univariable and multivariate analyses. RESULTS 76% of women developed CRA, of which only 40% resumed menses after treatment. Age at time of treatment and at menarche were significantly associated with CRA incidence, with higher rates linked to older age (≥ 40 years) and later menarche (at ≥ 13 years), in both univariable (P = 0.043 and P = 0.009, respectively) and multivariate (P = 0.010 and P = 0.012, respectively) analyses. Age at time of treatment, age at menarche and use of tamoxifen were significantly associated with resumption of menses (with greater resumption rates linked to younger age (< 40 years old), later menarche (≥ 13 years old) or no tamoxifen use status), in both univariable (P < 0.0001, P = 0.002 and P = 0.039, respectively) and multivariate (P = 0.001, P = 0.011 and P = 0.008, respectively) analyses. Menses resumption rates were also significantly higher (P = 0.015) in women with later cessation of menses (after 3-6 chemotherapy cycles rather than sooner). CONCLUSIONS Age at menarche and, specially, at time of treatment are important risk factors for CRA. These variables could aid decision-making for treatment selection and fertility preservation among premenopausal women with early breast cancer.
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27
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Anderson RA, Su HI. The Clinical Value and Interpretation of Anti-Müllerian Hormone in Women With Cancer. Front Endocrinol (Lausanne) 2020; 11:574263. [PMID: 33117288 PMCID: PMC7577190 DOI: 10.3389/fendo.2020.574263] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022] Open
Abstract
Cancer treatments can be damaging to the ovary, with implications for future fertility and reproductive lifespan. There is therefore a need for a biomarker than can usefully provide an assessment of the ovary and its potential for long-term function after cancer treatment, and ideally also be of value pre-treatment, for the prediction of post-treatment function. In this review we assess the value of anti-Müllerian hormone (AMH) in this context. Measurement of AMH at the time of cancer diagnosis has been shown to be predictive of whether or not there will remain some ovarian function post-treatment in women with breast cancer, in conjunction with age. AMH may however be reduced at the time of diagnosis in some conditions, including lymphoma, but probably not in women with breast cancer unless they are carriers of BRCA1 mutations. Following chemotherapy, AMH is often much reduced compared to pretreatment levels, with recovery dependent on the chemotherapy regimen administered, the woman's age, and her pretreatment AMH. Recent data show there may be a long duration of relative stability of AMH levels over 10 to 15 years prior to decline rather than a rapid decline for many young women after cancer. Post-treatment AMH may have utility in determining that ovarian function will not recover, contributing to assessment of the need for ovarian suppression in women with hormone-sensitive breast cancer. AMH measurement provides an index of treatment gonadotoxicity, allowing comparison of different treatment regimens, although extrapolation to effects on fertility requires caution, and there are very limited data regarding the use of AMH to estimate time to menopause in the post-cancer setting.
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Affiliation(s)
- Richard A. Anderson
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - H. Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
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28
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Impact of adjuvant chemotherapy or tamoxifen-alone on the ovarian reserve of young women with breast cancer. Breast Cancer Res Treat 2020; 185:165-173. [PMID: 32930927 DOI: 10.1007/s10549-020-05933-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/05/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the longitudinal impact of adjuvant chemotherapy and tamoxifen-only treatments on the reproductive potential of women with breast cancer by using a sensitive ovarian reserve marker anti-Mullerian hormone (AMH) as a surrogate. METHODS One-hundred-and-forty-two women with a primary diagnosis of breast cancer were prospectively followed with serum AMH assessments before the initiation, and 12, 18 and 24 months after the completion of adjuvant chemotherapy or the start of tamoxifen-only treatment. The chemotherapy regimens were classified into Anthracycline-Cyclophosphamide-based (AC-based) and Cyclophosphamide-Methotrexate + 5-Fluorouracil (CMF). Longitudinal data were analyzed by mixed effects model for treatment effects over time, adjusting for baseline age and BMI. RESULTS Both chemotherapy regimens resulted in significant decline in ovarian reserve compared to the tamoxifen-only treatment (p < 0.0001 either regimen vs. tamoxifen for overall trend). AMH levels sharply declined at 12 months but did not show a significant recovery from 12 to 18 and 18 to 24 months after the completion of AC-based or CMF regimens. The degree of decline did not differ between the two chemotherapy groups (p = 0.53). In contrast, tamoxifen-only treatment did not significantly alter the age-adjusted serum AMH levels over the 24-month follow up. Likewise, the use of adjuvant tamoxifen following AC-based regimens did not affect AMH recovery. CONCLUSIONS Both AC-based regimens and CMF significantly compromise ovarian reserve, without a recovery beyond 12 months post-chemotherapy. In contrast, tamoxifen-only treatment does not seem to alter ovarian reserve. These data indicate that the commonly used chemotherapy regimens but not the hormonal therapy compromise future reproductive potential.
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29
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Anderson RA, Wallace WHB. The Use of AMH to Assess Ovarian Toxicity in Adolescents and Young Adults After Cancer Treatment. J Clin Endocrinol Metab 2020; 105:5839885. [PMID: 32422659 PMCID: PMC7331875 DOI: 10.1210/clinem/dgaa277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, Scotland
- Correspondence and Reprint Requests: Richard A Anderson, MRC Centre for Reproductive Health, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, Scotland. E-mail:
| | - W Hamish B Wallace
- Department of Oncology and Haematology, The Royal Hospital for Sick Children, Edinburgh, Scotland
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30
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Su HI, Kwan B, Whitcomb BW, Shliakhsitsava K, Dietz AC, Stark SS, Martinez E, Sluss PM, Sammel MD, Natarajan L. Modeling Variation in the Reproductive Lifespan of Female Adolescent and Young Adult Cancer Survivors Using AMH. J Clin Endocrinol Metab 2020; 105:dgaa172. [PMID: 32270202 PMCID: PMC7329316 DOI: 10.1210/clinem/dgaa172] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/07/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Many female survivors of adolescent and young adult cancers (AYA survivors) have shortened reproductive lifespans. However, the timing and duration of ovarian function after cancer treatment are largely unknown. OBJECTIVE To model the trajectory of ovarian function over two decades following cancer treatment and evaluate how trajectories vary by treatment gonadotoxicity and age. DESIGN In a prospective cohort, AYA survivors aged 18-39 at variable times since cancer treatment completion provided dried blood spots (DBS) every 6 months for up to 18 months. Anti-Müllerian hormone (AMH) levels were measured using the Ansh DBS AMH enzyme-linked immunosorbent assay. The mean AMH trajectory was modeled for the entire cohort and separately by treatment gonadotoxicity and age using functional principal components analysis. RESULTS 763 participants, mean (standard deviation) enrollment age 33.3 (4.7) and age at cancer diagnosis 25.9 (5.7) years, contributed 1905 DBS samples. The most common cancers were breast (26.9%), lymphoma (24.8%), and thyroid (18.0%). AMH trajectories differed among survivors by treatment gonadotoxicity (low, moderate, or high) (P < 0.001). Following low or moderately gonadotoxic treatments, AMH levels increased over 2-3 years and plateaued over 10-15 years before declining. In contrast, following highly gonadotoxic treatment, AMH levels were lower overall and declined shortly after peak at 2-3 years. Younger age at treatment was associated with higher trajectories, but a protective effect of younger age was not observed in survivors exposed to highly gonadotoxic treatments (Pinteraction < 0.001). CONCLUSIONS In this large AYA survivor cohort, timing and duration of ovarian function strongly depended on treatment gonadotoxicity and age at treatment. The findings provide novel, more precise information to guide reproductive decision-making.
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Affiliation(s)
- H Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences and Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Massachusetts
| | - Ksenya Shliakhsitsava
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern, Dallas, Texas
| | - Andrew C Dietz
- Moores Cancer Center, University of California, San Diego, California
| | - Shaylyn S Stark
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Elena Martinez
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego, La Jolla, California
| | | | - Mary D Sammel
- Division of Biostatistics and Bioinformatics, School of Public Health, University of Colorado, Aurora, Colorado
| | - Loki Natarajan
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego, La Jolla, California
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31
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Lee DY, Kim JY, Yu J, Kim SW. Prediction of Successful Ovarian Protection Using Gonadotropin-Releasing Hormone Agonists During Chemotherapy in Young Estrogen Receptor-Negative Breast Cancer Patients. Front Oncol 2020; 10:863. [PMID: 32656076 PMCID: PMC7326007 DOI: 10.3389/fonc.2020.00863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/01/2020] [Indexed: 01/13/2023] Open
Abstract
Background: It is important to identify factors predicting successful ovarian protection using gonadotropin-releasing hormone (GnRH) agonists during chemotherapy. However, only a few studies have prospectively assessed this issue in young breast cancer patients. Objective: This study evaluated the predictive factors for successful ovarian protection with GnRH agonists during chemotherapy in young estrogen receptor-negative breast cancer patients. Materials and Methods: This prospective study analyzed 67 estrogen receptor-negative breast cancer patients ≤40 years of age who were longitudinally assessed after receiving GnRH agonists during cyclophosphamide-based chemotherapy for ovarian protection. Associations between clinical characteristics or pretreatment hormones and successful ovarian protection [resumption of menstruation and anti-Müllerian hormone (AMH) ≥1 ng/ml]. Results: The mean age and pretreatment serum level of AMH were 33.2 years and 4.57 ng/ml, respectively. At 12 months after the completion of chemotherapy, most women (97%) experienced the resumption of menstruation. However, the proportion of patients with AMH ≥1 ng/ml at 12 months was 70.1%. In multivariate analyses, only the pretreatment serum AMH level (P < 0.001) was predictive for AMH ≥1 ng/ml at 12 months. Receiver operating characteristic curve analyses of pretreatment AMH exhibited an area under the curve of 0.866 (95% CI = 0.777–0.955) for AMH ≥1 ng/ml at 12 months. The cutoff value for the prediction of AMH concentration ≥1 ng/ml at 12 months was 2.87 ng/ml of pretreatment AMH with a sensitivity of 0.87 and a specificity of 0.75. Conclusions: Pretreatment AMH (2.87 ng/ml) is a useful predictor for AMH ≥1 ng/ml at 12 months after receiving GnRH agonists in young estrogen receptor-negative breast cancer patients. This finding can help improve decision-making regarding fertility preservation.
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Affiliation(s)
- Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji-Yeon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jonghan Yu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seok Won Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Charo LM, Homer MV, Natarajan L, Haunschild C, Chung K, Mao JJ, DeMichele AM, Su HI. Drug metabolising enzyme polymorphisms and chemotherapy-related ovarian failure in young breast cancer survivors. J OBSTET GYNAECOL 2020; 41:447-452. [PMID: 32496149 DOI: 10.1080/01443615.2020.1754369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cyclophosphamide is associated with chemotherapy-related ovarian failure (CROF) in breast cancer survivors, however little is known about predicting individual risks. We sought to identify genetic alleles as biomarkers for risk of CROF after cyclophosphamide treatment. One hundred fifteen premenopausal women with newly diagnosed breast cancer were genotyped for single nucleotide polymorphisms (SNPs) in genes involved in cyclophosphamide activation (CYP3A4 and CYP2C19) and detoxification (GSTP1 and GSTA1). Patients prospectively completed menstrual diaries. With median follow up of 808 days, 28% experienced CROF. Survivors homozygous for the GSTA1 minor allele had lower hazards for developing CROF (HR 0.22 [95% CI 0.05-0.94], p=.04), while survivors homozygous for the CYP2C19 minor allele had higher hazards for developing CROF (HR 4.5 [95% CI 1.5-13.4], p=.007) compared to patients with at least one major allele. In separate multivariable models adjusting for age and tamoxifen use, the associations were no longer statistically significant (GSTA1 HR 0.24 [95% CI 0.06-1.0], p=.05; CYP2C19 HR 2.5 [0.8-7.6], p=.11). CYP3A4 and GSTP1 SNPs were not significantly related to CROF. In younger breast cancer survivors undergoing cyclophosphamide-based chemotherapy, genetic variation in CYP2C19 and GSTA1 merits further study to determine its relationship with CROF.IMPACT STATEMENTWhat is already known on this subject? Young breast cancer survivors face important potential implications of chemotherapy-related ovarian failure (CROF). Little is known about individual risk for CROF. Cyclophosphamide, a particularly gonadotoxic drug commonly used in breast cancer treatment, is metabolised by various cytochrome p450 enzymes. Studies have shown genetic variation in p450 enzymes is associated with differential clinical outcomes after cyclophosphamide treatment: breast cancer patients homozygous for GSTA1 minor allele had improved overall survival; lupus patients homozygous for CYP2C19 minor allele had increased risk for CROF; and CYP3A4*1B I was associated with decreased risk for CROF.What do the results of this study add? We show a surprising opposite trend for the risk of CROF in breast cancer patients with GSTA1 and CYP2C19 variants, while we did not show a significant risk for genetic variation in CYP3A4 (which had previously been shown to have a protective effect) or GSTP1.What are the implications of these findings for clinical practice and/or further research? This study shows the complexity of genetic variation in predicting outcomes to treatment. We advocate for future replicative studies to potentially validate GSTA1 and CYP2C19 and definitively negate CYP3A4 and GSTP1 as biomarkers for risk of CROF after cyclophosphamide treatment. Understanding genetic variation in chemotherapy metabolism has the potential to individualise treatment regimens to maximise efficacy and minimise toxicity.
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Affiliation(s)
- Lindsey M Charo
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA.,Moores Cancer Center, University of California, San Diego, CA, USA
| | - Michael V Homer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA
| | - Loki Natarajan
- Moores Cancer Center, University of California, San Diego, CA, USA.,Reproductive Division of Biostatistics and Bioinformatics, University of California, San Diego, CA, USA
| | - Carolyn Haunschild
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA
| | - Karine Chung
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Jun J Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Angela M DeMichele
- Department of Internal Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - H Irene Su
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA.,Moores Cancer Center, University of California, San Diego, CA, USA
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Oktay KH, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Increased chemotherapy-induced ovarian reserve loss in women with germline BRCA mutations due to oocyte deoxyribonucleic acid double strand break repair deficiency. Fertil Steril 2020; 113:1251-1260.e1. [PMID: 32331767 DOI: 10.1016/j.fertnstert.2020.01.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether woman who have BRCA mutations (WBM) experience more declines in ovarian reserve after chemotherapy treatment, as it induces oocyte death by deoxyribonucleic acid (DNA) damage, and BRCA mutations result in DNA damage repair deficiency. DESIGN Longitudinal cohort study. SETTING Academic centers. PATIENT(S) The 108 evaluable women with breast cancer were stratified into those never tested (negative family history; n = 35) and those negative (n = 59) or positive (n = 14) for a pathogenic BRCA mutation. INTERVENTION(S) Sera were longitudinally obtained before and 12-24 months after chemotherapy treatment, assayed for antimüllerian hormone (AMH), and adjusted for age at sample collection. MAIN OUTCOME MEASURE(S) Ovarian recovery, defined as the geometric mean of the after chemotherapy age-adjusted AMH levels compared with baseline levels. RESULT(S) Compared with the controls, the before chemotherapy treatment AMH levels were 24% and 34% lower in those negative or positive for BRCA mutations, consistent with accelerated ovarian aging in WBM. The WBM had a threefold difference in AMH recovery after chemotherapy treatment (1.6%), when compared with BRCA negative (3.7%) and untested/low risk controls (5.2%). Limiting the analysis to the most common regimen, doxorubicin and cyclophosphamide followed by paclitaxel, showed similar results. These findings were mechanistically confirmed in an in vitro mouse oocyte BRCA knockdown bioassay, which showed that BRCA deficiency results in increased oocyte susceptibility to doxorubicin. CONCLUSION(S) Women who have pathogenic BRCA mutations are more likely to lose ovarian reserve after chemotherapy treatment, suggesting an emphasis on fertility preservation. Furthermore, our findings generate the hypothesis that DNA repair deficiency is a shared mechanism between aging, infertility, and cancer. CLINICAL TRIAL REGISTRATION NUMBER NCT00823654.
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Affiliation(s)
- Kutluk H Oktay
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Giuliano Bedoschi
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | | | - Enes Taylan
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Shiny Titus
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, Rhode Island
| | - Tessa Cigler
- Weill Medical College of Cornell University, New York, New York
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
OBJECTIVE More than 5,000 premenopausal women are diagnosed with lung cancer annually in the United States. Limited data exist regarding the risk of treatment-related amenorrhea, a surrogate for infertility and early menopause, after systemic therapies for lung cancer. METHODS Premenopausal women diagnosed with lung cancer under age 50 were surveyed at diagnosis and annually thereafter about their menstrual status as a part of the Mayo Clinic Epidemiology and Genetics of Lung Cancer Research Program. Types of lung cancer-directed treatments were recorded, and frequencies of self-reported menopause at each survey were calculated. RESULTS A cohort of 182 premenopausal women were included in this study, with average age at lung cancer diagnosis 43 years (SD 6). Among the 85 patients who received chemotherapy, 64% self-reported that they had become menopausal within a year of diagnosis. Platinum salts were universally included in these chemotherapy regimens, and the majority of these women also received taxanes within 1 year of diagnosis. Only 15% of the 94 patients who did not receive systemic therapy within 1 year of diagnosis experienced self-reported menopause. Three patients received targeted therapy alone, two of whom remained premenopausal at the final qualifying survey, completed a median of 3 years after diagnosis. CONCLUSIONS Chemotherapy for lung cancer patients appears to increase risk of early loss of menses in survivors.
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Hussein RS, Khan Z, Zhao Y. Fertility Preservation in Women: Indications and Options for Therapy. Mayo Clin Proc 2020; 95:770-783. [PMID: 32247351 DOI: 10.1016/j.mayocp.2019.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 01/21/2023]
Abstract
Fertility preservation (FP) is a vital issue for individuals in either reproductive or prepubescent stage of life when future fertility may be compromised. The objective of any FP intervention is to minimize or eliminate primary disease burden and to ensure maintaining or preserving reproductive health. Fertility potential can be affected by cancer therapy and numerous other factors, including advancing age, metabolic conditions, autoimmune diseases, specific surgical interventions, and sex affirmation procedures. A paradigm shift focusing on quality-of-life issues and long-term survivorship has emerged, especially because of advances in cancer diagnostics and treatment. Several FP techniques have been widely distributed, while others are still in the research stage. In addition, specific procedures and some potentially fertoprotective agents are being developed, aiming to minimize the hazards of gonadal damage caused by cancer therapy and decrease the need for more costly, invasive, and time-consuming FP methods. This review highlights the advances, indications, and options for FP, both experimental and well-established, in females of various age groups. An electronic search in PubMed, Embase, and Google Scholar databases was conducted, including retrospective studies, prospective clinical trials, meta-analyses, original reviews, and online abstracts published up to June 30, 2019. The search terms used included fertility preservation, oncofertility, embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. The meeting proceedings of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology were also hand searched.
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Affiliation(s)
- Reda S Hussein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Yulian Zhao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Hashem KS, Elkelawy AMMH, Abd-Allah S, Helmy NA. Involvement of Mfn2, Bcl2/Bax signaling and mitochondrial viability in the potential protective effect of Royal jelly against mitochondria-mediated ovarian apoptosis by cisplatin in rats. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2020; 23:515-526. [PMID: 32489567 PMCID: PMC7239429 DOI: 10.22038/ijbms.2020.40401.9563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/09/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The current study aimed to assess cisplatin-mediated ovarian apoptosis in a rat model by Royal jelly (RJ). MATERIALS AND METHODS Thirty female adult albino rats (180-200 g) were divided into three groups (n=10): saline (0.9% NaCl, IP) was given to the control group, the cisplatin group: received (5 mg/kg/once a week IP) for 5 successive weeks, the RJ+Cis. group: received RJ (100 mg/kg/ day PO daily), and Cisplatin (5 mg/kg/once per week IP) for 5 successive weeks. At the end of the experiment, rats were sacrificed and their ovaries were isolated and used for biochemical analysis, molecular investigations and morphometric assessment as well as histological study. Moreover, blood samples were collected for determination of follicle-stimulating hormone (FSH), luteinizing hormone (LH), Estradiol, progesterone and anti-mullerian hormone (AMH). RESULTS The current study clarified that RJ given to rats prior to cisplatin significantly increased the ovarian and uterine weights, in addition to follicular count at P˂0.05 compared to rats injected only with cisplatin. Moreover, it restored normal ovarian histological structure with a concurrent reduction in FSH, and LH levels, and increased AMH and ovarian hormone concentrations at P˂0.05 compared to cisplatin group. Also, RJ decreased the ovarian antioxidant/oxidative imbalance harmonized with significant suppression of inducible nitric oxide synthase and increase of quinone oxidoreductase 1 mRNA expression at P˂0.05 compared to cisplatin group. CONCLUSION We concluded that RJ could alleviate mitochondrial-induced ovarian apoptosis caused by cisplatin via increasing anti-apoptotic Bcl2, and diminishing pro-apoptotic Bax with a concomitant increase of Mfn2 mRNA and protein expressions.
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Affiliation(s)
- Khalid S. Hashem
- Department of Biochemistry, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | - Saber Abd-Allah
- Department of Theriogenology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Nermeen A. Helmy
- Department of Physiology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt
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Çelebi F, Ordu Ç, Ilgün S, Oztürk A, Erdoğan Iyigün Z, Alço G, Duymaz T, Aktepe F, Soybir G, Baysal B, Özmen V. The Effect of Systemic Chemotherapy on Ovarian Function: A Prospective Clinical Trial. Eur J Breast Health 2020; 16:177-182. [PMID: 32656517 DOI: 10.5152/ejbh.2020.5114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022]
Abstract
Objective Premenopausal women with breast cancer are at risk of developing ovarian failure after chemotherapy. The aim of this study was to investigate the negative effects of systemic chemotherapy on ovarian function in premenoupausal women with breast cancer. Materials and Methods Thirty-one premenopausal women with operable breast cancer aged between 26-48 years were enrolled in this prospective cohort study to investigate preliminary results. Additional 69 patients' data will be included after the completion of all five measurements. The change in serum Antimullerian Hormone (AMH) levels, mean ovarian volumes (MOV) and antral follicle counts (AFCs) at 3-month intervals were recorded to evaluate ovarian function. Women who had at least one pretreatment and four post-treatment measurements in one year follow-up period were included in the study. Decision of chemotherapy regimen was taken by the Tumor Board. Results Thirty-one patients had all five AMH, MOV and AFCs results. There was a statistically significant negative correlation between 1st - 5th AMH levels (p=0.006) and 1st - 5th AFCs during the follow-up period (p<0.0001). However pre- and post-chemotherapy measurements of MOVs did not demonstrate any significant correlation (p=0.799). BMI, parity, lactation, histopathology and molecular subtypes of breast cancer, alcohol intake, smoking and type of chemotherapy regimen were not significantly correlated with AMH, AFC and MOV. Conclusion Pretreatment AMH levels and AFC were shown to have a significant role in early prediction of ovarian-reserve after chemotherapy.
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Affiliation(s)
- Filiz Çelebi
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Department of Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Serkan Ilgün
- Department of General Surgery, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Alper Oztürk
- Department of General Surgery, Biruni University Hospital, İstanbul, Turkey
| | - Zeynep Erdoğan Iyigün
- Department of Physical Therapy and Rehabilitation, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, Bilgi University, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Etiler Hospital, İstanbul, Turkey
| | - Bülent Baysal
- Department of Obstetrics and Gynecology, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
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Abstract
Over the past decades, progresses in oncology have improved the recovery rates after numerous malignant diseases, including breast cancer, that strike young adults in childbearing age. Quality of life of young cancer survivors has become a major issue. However, anticancer therapies can have a detrimental impact on fertility. It is now well-established that all patients should receive information about the fertility risks associated with their cancer treatment and the fertility preservation options available. These techniques aim to limit the negative impact of chemotherapy on the ovaries or to preserve gametes before treatment. Currently, oocyte or embryo freezing after controlled ovarian hyperstimulation represents the most effective method for preserving female fertility. Over the past years innovative protocols of ovarian stimulation have been developed to enable breast cancer patients to undergo oocyte or embryo cryopreservation irrespective of the phase of the cycle or without exogenous follicle-stimulating hormone related increase in serum estradiol levels. When controlled ovarian hyperstimualtion cannot be implemented, other techniques such as cryopreservation of ovarian cortex, in vitro maturation or the use of GnRH agonists may be proposed. However, it is important to inform patients that all these fertility preservation techniques do not represent a guarantee of pregnancy.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 92140 Clamart, France; INSERM U1185, Université Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Michaël Grynberg
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 92140 Clamart, France; INSERM U1133, Université Paris-Diderot, 75013 Paris, France; Université Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France.
| | - Sophie Bringer
- Service de gynécologie-obstétrique et médecine de la reproduction, CHRU, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction - CECOS, hôpital Tenon, 75020 Ap-HP, Paris, France
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Edib Z, Jayasinghe Y, Hickey M, Stafford L, Anderson RA, Su HI, Stern K, Saunders C, Anazodo A, Macheras-Magias M, Chang S, Pang P, Agresta F, Chin-Lenn L, Cui W, Pratt S, Gorelik A, Peate M. Exploring the facilitators and barriers to using an online infertility risk prediction tool (FoRECAsT) for young women with breast cancer: a qualitative study protocol. BMJ Open 2020; 10:e033669. [PMID: 32047016 PMCID: PMC7044829 DOI: 10.1136/bmjopen-2019-033669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION As cancer treatments may impact on fertility, a high priority for young patients with breast cancer is access to evidence-based, personalised information for them and their healthcare providers to guide treatment and fertility-related decisions prior to cancer treatment. Current tools to predict fertility outcomes after breast cancer treatments are imprecise and do not offer individualised prediction. To address the gap, we are developing a novel personalised infertility risk prediction tool (FoRECAsT) for premenopausal patients with breast cancer that considers current reproductive status, planned chemotherapy and adjuvant endocrine therapy to determine likely post-treatment infertility. The aim of this study is to explore the feasibility of implementing this FoRECAsT tool into clinical practice by exploring the barriers and facilitators of its use among patients and healthcare providers. METHODS AND ANALYSIS A cross-sectional exploratory study is being conducted using semistructured in-depth telephone interviews with 15-20 participants each from the following groups: (1) premenopausal patients with breast cancer younger than 40, diagnosed within last 5 years, (2) breast surgeons, (3) breast medical oncologists, (4) breast care nurses (5) fertility specialists and (6) fertility preservation nurses. Patients with breast cancer are being recruited from the joint Breast Service of three affiliated institutions of Victorian Comprehensive Cancer Centre in Melbourne, Australia-Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Royal Women's Hospital, and clinicians are being recruited from across Australia. Interviews are being audio recorded, transcribed verbatim and imported into qualitative data analysis software to facilitate data management and analyses. ETHICS AND DISSEMINATION The study protocol has been approved by Melbourne Health Human Research Ethics Committee, Australia (HREC number: 2017.163). Confidentiality and privacy are maintained at every stage of the study. Findings will be disseminated through peer-reviewed scholarly and scientific journals, national and international conference presentations, social media, broadcast media, print media, internet and various community/stakeholder engagement activities.
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Affiliation(s)
- Zobaida Edib
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Yasmin Jayasinghe
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Martha Hickey
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lesley Stafford
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Women's Mental Health, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - H Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California, USA
| | - Kate Stern
- Melbourne IVF, East Melbourne, Victoria, Australia
- Reproductive Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Christobel Saunders
- School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Antoinette Anazodo
- Sydney Children's Hospital, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Children's Hospital, Randwick, New South Wales, Australia
| | | | - Shanton Chang
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Pang
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Franca Agresta
- Melbourne IVF, East Melbourne, Victoria, Australia
- Reproductive Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Laura Chin-Lenn
- Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wanyuan Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sarah Pratt
- Breast Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alex Gorelik
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Michelle Peate
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
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Fertility preservation and preimplantation genetic assessment for women with breast cancer. Cryobiology 2020; 92:1-8. [DOI: 10.1016/j.cryobiol.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
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Wakimoto Y, Fukui A, Wakimoto G, Ikezawa Y, Matsuoka M, Omote M, Sugiyama Y, Ukita Y, Kato T, Shibahara H. Association between spontaneous ovulation and serum anti-Müllerian hormone levels in a premature ovarian insufficiency patient after a multimodal treatment for breast cancer. J Obstet Gynaecol Res 2019; 45:2297-2301. [PMID: 31456293 DOI: 10.1111/jog.14101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
Abstract
The high toxicity of chemotherapy can damage a patient's gonadal function, leading to premature ovarian insufficiency (POI). Here, we report the case of a patient suffering from POI after chemotherapy for breast cancer, who 3 years later ovulated spontaneously and became pregnant. The patient, a 31-year-old infertile women, nulligravida, was diagnosed with breast cancer. The Anti-Müllerian Hormone (AMH) level in her serum was 1.85 ng/mL before multimodal treatment for cancer. She later visited our hospital for amenorrhea and 2 years after cancer treatment, she was diagnosed with POI. Her AMH level at that point was less than 0.1 ng/mL. One year after the diagnosis of POI, the patient's AMH level increased slightly to 0.14 ng/mL and she ovulated spontaneously. The patient later became pregnant using Assisted Reproductive Technology on the fourth attempt.During the course of treatment for infertility at our hospital, the AMH levels in her serum changed along with the recovery of ovarian function. These findings suggest the possibility that ovulation and pregnancy could be predicted by the chronological changes of the AMH levels in the patient's serum.
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Affiliation(s)
- Yu Wakimoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Atushi Fukui
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Goh Wakimoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuji Ikezawa
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Michie Matsuoka
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Maya Omote
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yukiko Sugiyama
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuji Ukita
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toru Kato
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Tan R, He Y, Zhang S, Pu D, Wu J. Effect of transcutaneous electrical acupoint stimulation on protecting against radiotherapy- induced ovarian damage in mice. J Ovarian Res 2019; 12:65. [PMID: 31324205 PMCID: PMC6642573 DOI: 10.1186/s13048-019-0541-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023] Open
Abstract
Background Premature ovarian insufficiency (POI) is characterized by early loss of ovarian function that affects women before the age of 40. We aim to explore the protective effects of transcutaneous electrical acupoint stimulation (TEAS) against irradiation-induced ovarian damage in mice. Methods C57BL6 mice were randomly divided into control and irradiation (IR) groups. Then, control group was divided into two treatment subgroups: mock TEAS treatment (control-) and TEAS treatment (control+). IR group was divided into four subgroups according to the time of treatment started: mock TEAS treatment initiated at 2 days after irradiation (IR 2D-), TEAS treatment initiated at 2 days after irradiation (IR 2D+), mock TEAS treatment initiated at 1 week after irradiation (IR 1 W-), and TEAS treatment initiated at 1 week after irradiation (IR 1 W+). The radiation model mice were exposed to single whole body X-ray irradiation (4 Gy), and the control mice received 0 Gy. TEAS stimulation (2 Hz, 1 mA, 30 min/day) was given once a day for six consecutive days per week for 2 weeks. Estrous cycle, ovarian weight, serum AMH level and follicle counts were evaluated. Then, proliferation markers, apoptotic markers and oxidative stress markers were examined. Results Compared with the control group, the estrous cycle was disordered, and the ovarian weight, serum AMH, and primordial, primary and secondary follicles counts decreased (all P < 0.01) in the IR 2D- and IR 1 W- groups. In the irradiation with early TEAS treatment group (IR 2D+), the estrous cycle improved, the AMH level and primordial follicular significantly increased compared to the irradiation with mock group (IR 2D-). However, there were no significant differences in the estrous cycle, AMH level and follicle counts between IR 1 W- and IR 1 W+ groups. Moreover, IR 2D+ mice reduced the expression of Bax protein and increased the levels of Bcl-2 and PCNA compared to the IR 2D- group. Furthermore, the early TEAS treated mice showed significantly lower levels of oxidative stress and number of TUNEL (+) granulosa cells than that in the IR 2D- group. Conclusion This study is first to evaluate TEAS as a potential therapy to attenuate irradiation-induced ovarian failure through inhibiting primordial follicles loss, increasing serum AMH secretion, inducing antioxidant, and anti-apoptotic systems.
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Affiliation(s)
- Rongrong Tan
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Yuheng He
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Suyun Zhang
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Danhua Pu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Jie Wu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, 210029, People's Republic of China.
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Palinska-Rudzka KE, Ghobara T, Parsons N, Milner J, Lockwood G, Hartshorne GM. Five-year study assessing the clinical utility of anti-Müllerian hormone measurements in reproductive-age women with cancer. Reprod Biomed Online 2019; 39:712-720. [PMID: 31471141 DOI: 10.1016/j.rbmo.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/03/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION An important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve? DESIGN A prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18-43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up. RESULTS After adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancer patients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis). CONCLUSIONS Reproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy.
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Affiliation(s)
- K E Palinska-Rudzka
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - T Ghobara
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - N Parsons
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK
| | - J Milner
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G Lockwood
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G M Hartshorne
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK.
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Recent Advances in Fertility Preservation and Counseling for Reproductive-Aged Women with Colorectal Cancer: A Systematic Review. Dis Colon Rectum 2019; 62:762-771. [PMID: 30730458 DOI: 10.1097/dcr.0000000000001351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The incidence of colorectal cancer among reproductive-aged women is increasing. Concerns regarding future fertility are secondary only to concerns regarding survival and may significantly impact quality of life among reproductive-aged female cancer survivors. Fertility preservation counseling reduces long-term regret and dissatisfaction among cancer survivors. Health care providers counseling patients with colorectal cancer must understand the impact of cancer treatment on future reproductive potential. OBJECTIVE This review aims to examine the effects that colorectal cancer treatments have on female fertility and summarize existing and emerging options for fertility preservation. DATA SOURCES EMBASE, National Library of Medicine (MEDLINE)/PubMed, Cochrane Review Library were the data sources for this review. STUDY SELECTION A systematic literature review was performed using exploded MeSH terms to identify articles examining the effect of surgery, chemotherapy, and radiation, as well as fertility preservation options for colorectal cancer on female fertility. Relevant studies were included. MAIN OUTCOME MEASURES The primary outcome was the effect of colorectal cancer treatment on fertility. RESULTS There are limited data regarding the impact of colorectal surgery on fertility. The gonadotoxic effects of chemotherapy on reproductive capacity depend on age at the time of chemotherapy administration, cumulative chemotherapy, radiation dose, type of agent, and baseline fertility status. Chemotherapy-induced risks for colorectal cancers are considered low to moderate, whereas pelvic radiation with a dose of 45 to 50 Gray induces premature menopause in greater than 90% of patients. Ovarian transposition may reduce but not eliminate the damaging effect of radiation on the ovaries. Embryo and oocyte cryopreservation are considered standard of care for women desiring fertility preservation, with oocyte cryopreservation no longer being considered experimental. Ovarian tissue cryopreservation remains experimental but may be an option for select patients. The use of gonadotropin-releasing hormone agonists remains controversial and has not been definitively shown to preserve fertility. LIMITATIONS The limitations of this review are the lack of randomized controlled trials and high-quality studies, as well as the small sample sizes and the use of surrogate fertility markers. CONCLUSION Reproductive-aged women with colorectal cancer benefit from fertility preservation counseling before the initiation of cancer treatment.
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Abstract
PURPOSE OF REVIEW There are competing risks and benefits of cancer therapies and fertility preservation in young women with breast cancer. Here we discuss the impact of therapy on fertility, fertility preservation options, and emerging information in fertility issues for the breast cancer patient. RECENT FINDINGS All systemic forms of breast cancer treatment can impact future fertility. Pre-therapy fertility preservation may offer the best opportunity for future fertility. Shared decision making with the individual patient and clinical scenario is important. Early referral to a fertility specialist should be offered to young patients. We find that fertility preservation options for young women diagnosed with breast cancer are currently available, but potentially under-utilized. We conclude that a multidisciplinary approach is necessary, with discussion of potential risks and benefits of fertility preservation options in the context of the patient's clinical disease.
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Affiliation(s)
- Nicole Christian
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
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Cameron K, Sammel MD, Prewitt M, Gracia C. Differential Rates of Change in Measures of Ovarian Reserve in Young Cancer Survivors Across the Reproductive Lifespan. J Clin Endocrinol Metab 2019; 104:1813-1822. [PMID: 30566616 PMCID: PMC6456010 DOI: 10.1210/jc.2018-02257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent studies have examined level and rate of change of anti-Müllerian hormone (AMH) for predicting time to menopause. Limited prospective, longitudinal data exists evaluating measures of ovarian reserve (MOR) in cancer survivors. PURPOSE Determine the rate of change of MOR in survivors (15 to 39 years) compared with similar-aged controls and compared with late reproductive-aged controls (40 to 50 years). DESIGN Prospective cohort. SETTING Quaternary university hospital. PARTICIPANTS Survivors at least 1 year from therapy completion, similar-aged controls, and late reproductive-aged controls. INTERVENTIONS Annual visits with early follicular-phase hormone analysis and ultrasound. MAIN OUTCOME MEASURE Changes in AMH and antral follicle count (AFC) were modeled using random effects linear regression. RESULTS Cancer survivors (170) and 135 similar-aged controls had annual visits for an average of 38 months; 71 late reproductive-aged controls were followed for an average of 24 months. In models adjusted for body mass index, time since cancer therapy (for survivors), and exogenous hormone use, the geometric mean AMH and AFC levels were lower in the survivors than similar-aged controls at all ages. After age 24.5 AMH and AFC declined in both groups at rates that were similar (P = 0.78 for AMH, P = 0.37 for AFC). Late reproductive-aged controls declined at a much more precipitous rate of 30% per year for AMH and 16% per year for AFC (P < 0.01 compared with survivors). CONCLUSIONS Although survivors had lower levels of AMH and AFC at the time of enrollment, the rate of change of AMH and AFC is not significantly different than similar-aged controls.
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Affiliation(s)
- Katherine Cameron
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
- Correspondence and Reprint Requests: Katherine Cameron, MD, MBE, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. E-mail:
| | - Mary D Sammel
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Maureen Prewitt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clarisa Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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Grossesse après cancer du sein : revue de la littérature. Presse Med 2019; 48:376-383. [DOI: 10.1016/j.lpm.2019.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 02/14/2017] [Accepted: 01/31/2019] [Indexed: 11/18/2022] Open
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Letourneau J, Fair D. Oncofertility in urologic oncology: Fertility preservation for women undergoing cancer treatment. Urol Oncol 2019; 38:14-22. [PMID: 30826168 DOI: 10.1016/j.urolonc.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
Thousands of reproductive age women are treated for urologic malignancies each year in the United States. Treatments for advanced bladder and renal cancers have the potential to affect future fertility in female patients. The American Society of Clinical Oncology and the American Society of Reproductive Medicine recognize the importance of fertility preservation, categorizing it as a necessary part of medical care. Iatrogenic infertility has a tremendous impact on quality of life in survivors' of cancer. Fertility preservation counseling and treatment can improve long-term quality of life, therefore access to such counseling and treatment should be expanded.
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Affiliation(s)
- Joseph Letourneau
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake city, UT; University of Utah School of Medicine Department of Pediatric Oncology and also with Primary Children's Hospital, Salt Lake City, UT.
| | - Douglas Fair
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake city, UT; University of Utah School of Medicine Department of Pediatric Oncology and also with Primary Children's Hospital, Salt Lake City, UT
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Pascuali N, Scotti L, Di Pietro M, Oubiña G, Bas D, May M, Gómez Muñoz A, Cuasnicú PS, Cohen DJ, Tesone M, Abramovich D, Parborell F. Ceramide-1-phosphate has protective properties against cyclophosphamide-induced ovarian damage in a mice model of premature ovarian failure. Hum Reprod 2019. [PMID: 29534229 DOI: 10.1093/humrep/dey045] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY QUESTION Is ceramide-1-phosphate (C1P) an ovarian protective agent during alkylating chemotherapy? SUMMARY ANSWER Local administration of C1P drastically reduces ovarian damage induced by cyclophosphamide (Cy) via protection of follicular reserve, restoration of hormone levels, inhibition of apoptosis and improvement of stromal vasculature, while protecting fertility, oocyte quality and uterine morphology. WHAT IS KNOWN ALREADY Cancer-directed therapies cause accelerated loss of ovarian reserve and lead to premature ovarian failure (POF). Previous studies have demonstrated that C1P regulates different cellular processes including cell proliferation, cell migration, angiogenesis and apoptosis. This sphingolipid may be capable of modulating vascular development and apoptosis in ovaries affected by chemotherapy. STUDY DESIGN, SIZE, DURATION The 6-8-week-old mice were weighed and administered either a single intraperitoneal injection of Cy (75 mg/kg) or an equal volume of saline solution only for control mice. Control and Cy mice underwent sham surgery and received an intrabursal injection of saline solution, while Cy + C1P animal groups received 5 μl C1P, either 0.5 or 1 mM, under the bursa of both ovaries 1 h prior to Cy administration. PARTICIPANTS/MATERIALS, SETTING, METHODS Animals were euthanized by cervical dislocation or cardiac puncture 2 weeks after surgery for collection of blood orovary and uterus samples, which were cleaned of adhering tissue in culture medium and used for subsequent assays. Ovaries were used for Western blotting or immunohistochemical and/or histological analyses or steroid extraction, as required (n = 5-8 per group). A set of mice (n = 3/group) was destined for oocyte recovery and IVF. Finally, another set (n = 5-6/group) was separated to study fertility parameters. MAIN RESULTS AND THE ROLE OF CHANCE The number of primordial (P < 0.01), primary (P < 0.05) and preantral follicles (P < 0.05) were decreased in Cy-treated mice compared to control animals, while atretic follicles were increased (P < 0.001). In Cy + C1P mice, the ovaries recovered control numbers of these follicular structures, in both C1P doses studied. Cy affected AMH expression, while it was at least partially recovered when C1P is administered as well. Cy caused an increase in serum FSH concentration (P < 0.01), which was prevented by C1P coadministration (P < 0.01). E2 levels in Cy-treated ovaries decreased significantly compared to control ovaries (P < 0.01), whilst C1P restored E2 levels to those of control ovaries (P < 0.01). Cy increased the expression of BAX (P < 0.01) and decreased the expression of BCLX-L compared to control ovaries (P < 0.01). The ovarian BCLX-L:BAX ratio was also lower in Cy-treated mice (P < 0.05). In the Cy + C1P group, the expression levels of BAX, BCLX-L and BCLX-L:BAX ratio were no different than those in control ovaries. In addition, acid sphingomyelinase (A-SMase) expression was higher in Cy-treated ovaries, whilst remaining similar to the control in the Cy + C1P group. Cy increased the apoptotic index (TUNEL-positive follicles/total follicles) in preantral and early antral stages, compared to control ovaries (P < 0.001 and P < 0.01, respectively). C1P protected follicles from this increase. No primordial or primary follicular cells stained for either cleaved caspase-3 or TUNEL when exposed to Cy, therefore, we have found no evidence for follicular reserve depletion in response to Cy being due to apoptosis. Cy caused evident vascular injury, especially in large cortical stromal vessels, and some neovascularization. In the Cy + C1P group, the disruptions in vascular wall continuity were less evident and the number of healthy stromal blood vessels seemed to be restored. In Cy-treated ovaries α-SMA-positive cells showed a less uniform distribution around blood vessels. C1P coadministration partially prevented this Cy-induced effect, with a higher presence of α-SMA-positive cells surrounding vessels. By H&E staining, Cy-treated mice showed endometrial alterations compared to controls, affecting both epithelial and stromal compartments. However, C1P allowed that the stromal tissue to maintain its loose quality and its glandular branches. Cy-treated animals had significantly lower pregnancy rates and smaller litter sizes compared with control mice (P = 0.013 and P < 0.05, respectively), whereas cotreatment with C1P preserved normal fertility. Furthermore, a higher (P < 0.05) proportion of abnormal oocytes was recovered from Cy-treated mice compared to the control, which was prevented by C1P administration. LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION The results of this study were generated from an in-vivo animal experimental model, already used by several authors. Further studies on C1P functions in female reproduction in pathological conditions such as chemotherapy-induced ovarian failure and on the safety of use of this sphingolipid are required. WIDER IMPLICATIONS OF THE FINDINGS The present findings showed that C1P administration prior to Cy might be a promising fertility preservation strategy in female patients who undergo chemotherapy. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants from ANPCyT (PICT 2015-1117), CONICET (PIP 380), Cancer National Institute (INC) and Roemmers Foundation, Argentina. The authors declare no conflicts of interest.
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Affiliation(s)
- Natalia Pascuali
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Leopoldina Scotti
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Mariana Di Pietro
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Gonzalo Oubiña
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Diana Bas
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - María May
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Antonio Gómez Muñoz
- Department of Biochemistry and Molecular Biology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Patricia S Cuasnicú
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Débora J Cohen
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Marta Tesone
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Dalhia Abramovich
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
| | - Fernanda Parborell
- IInstituto de Biología y Medicina Experimental (IByME-CONICET), Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina
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Wong QHY, Anderson RA. The role of antimullerian hormone in assessing ovarian damage from chemotherapy, radiotherapy and surgery. Curr Opin Endocrinol Diabetes Obes 2018; 25:391-398. [PMID: 30299433 PMCID: PMC6226218 DOI: 10.1097/med.0000000000000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Iatrogenic ovarian damage can occur after chemotherapy, radiotherapy and surgery for cancer as well as for non-malignant conditions. This review describes the effects of such treatment on antimullerian hormone (AMH) and the implications of the fall in AMH in relation to ovarian function and fertility, especially in the era of improved fertility preservation strategies. RECENT FINDINGS The risk of gonadotoxicity differs between chemotherapy regimens. There is growing evidence that pretreatment AMH has prognostic significance for the degree of fall in AMH after treatment, the reversibility of ovarian damage and risk of premature ovarian insufficiency. The accuracy of prediction increases when age is coupled with AMH. The adverse effect of removal of endometriomas is increasingly clear, and AMH pre and post surgery useful is assessing the degree of damage to the ovary. The implications of low AMH after such treatment on natural fertility and reproductive lifespan are less clear. Apart from treatment effects, there are other coexisting conditions that can affect AMH which needs to be taken into consideration during interpretation of AMH before and after treatment. SUMMARY A fall in AMH in women after gonadotoxic treatment has been consistently described, with variable recovery, the accurate interpretation and clinical application of post-treatment AMH level on reproductive lifespan and fertility prediction needs to be studied in future larger prospective studies with longer follow-up.
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Affiliation(s)
- Queenie Ho Yan Wong
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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