Anti‐Müllerian Hormone and Antral Follicle Count Reveal a Late Impairment of Ovarian Reserve in Patients Undergoing Low‐Gonadotoxic Regimens for Hematological Malignancies

• Published in: The oncologist (Dayton, Ohio) Vol. 18; no. 12; pp. 1307 - 1314
• Main Authors: Di Paola, Rossana, Costantini, Claudio, Tecchio, Cristina, Salvagno, Gian Luca, Montemezzi, Rachele, Perandini, Alessio, Pizzolo, Giovanni, Zaffagnini, Stefano, Franchi, Massimo
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.12.2013
• Subjects: Adolescent; Anti-Mullerian Hormone - analysis; Anti‐Müllerian hormone; Antral follicle count; Case-Control Studies; Female; Fertility Preservation; Gynecologic Oncology; Hematologic Neoplasms - drug therapy; Hematologic Neoplasms - physiopathology; Hematologic Neoplasms - radiotherapy; Hematological malignancies; Humans; Inhibin-beta Subunits - blood; Ovarian Follicle - diagnostic imaging; Ovarian Follicle - drug effects; Ovarian Follicle - physiopathology; Ovarian Follicle - radiation effects; Ovary - diagnostic imaging; Ovary - drug effects; Ovary - physiopathology; Ovary - radiation effects; Survivors; Ultrasonography; Young Adult; Anti-Müllerian hormone; Antral follicle count; Fertility preservation; Hematological malignancies
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2013-0138

The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case‐control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age‐matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy received and time elapsed from the end of the therapy, we report that patients treated with low gonadotoxic therapies, while being similar to age‐matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti‐Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle‐stimulating hormone or inhibin‐B. This study stresses the importance of accurate counseling at the time of diagnosis of cancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors. Patients treated with low gonadotoxic therapies show clear impairment of their ovarian reserves over longer times when evaluated within few years from the end of the therapy and compared with age‐matched controls. This study stresses the importance of accurate counseling at the time of diagnosis of cancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors.