Richard A Anderson1, David A Cameron. 1. Division of Reproduction and Developmental Sciences and Medical Research Council Human Reproductive Sciences Unit, Centre for Reproductive Biology, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom. richard.anderson@ed.ac.uk
Abstract
CONTEXT: Administration of chemotherapy to premenopausal women shortens their reproductive lifespan by depleting nonrenewable oocytes. Preservation of fertility is a priority for many such women, and identification of women at risk of infertility is therefore important. However, age is the only patient characteristic currently recognized to be predictive of long-term ovarian function after chemotherapy. OBJECTIVE: Our objective was to assess markers of ovarian reserve and age as long-term predictors of ovarian function after chemotherapy. DESIGN AND SETTING: We conducted a prospective, longitudinal study at a university hospital and research institute. PATIENTS: Patients included women who were premenopausal at the time of diagnosis of early breast cancer. MAIN OUTCOME MEASURES: Ovarian function was assessed at 5 yr follow-up in relation to pretreatment hormonal and ultrasound markers of ovarian reserve. RESULTS: Forty-two women received (neo-)adjuvant chemotherapy. Continuing menses 4-5 yr after diagnosis closely reflected ovarian activity as assessed by a range of serum markers, including estradiol, inhibin B, FSH, and anti-müllerian hormone (AMH). Pretreatment serum AMH, FSH, antral follicle count, and age predicted late ovarian activity by univariate analysis. However, only AMH was predictive in a multivariate logistic regression (odds ratio = 13.0; 95% confidence interval = 2.5-66.7); 0.71 ng/ml gave peak likelihood ratio of 7.0 with 54% sensitivity and 92% specificity. Bone mineral density fell over the 4-5 yr after diagnosis with greater loss in women with lower ovarian activity. Higher pretreatment AMH was associated with lower bone mineral density at both lumbar spine and hip at 5 yr (P < 0.02). CONCLUSION: Measurement of AMH at cancer diagnosis predicts long-term ovarian function after chemotherapy. Use of this in clinical practice may allow better prediction of chemotherapy-related risk to future fertility.
CONTEXT: Administration of chemotherapy to premenopausal women shortens their reproductive lifespan by depleting nonrenewable oocytes. Preservation of fertility is a priority for many such women, and identification of women at risk of infertility is therefore important. However, age is the only patient characteristic currently recognized to be predictive of long-term ovarian function after chemotherapy. OBJECTIVE: Our objective was to assess markers of ovarian reserve and age as long-term predictors of ovarian function after chemotherapy. DESIGN AND SETTING: We conducted a prospective, longitudinal study at a university hospital and research institute. PATIENTS: Patients included women who were premenopausal at the time of diagnosis of early breast cancer. MAIN OUTCOME MEASURES: Ovarian function was assessed at 5 yr follow-up in relation to pretreatment hormonal and ultrasound markers of ovarian reserve. RESULTS: Forty-two women received (neo-)adjuvant chemotherapy. Continuing menses 4-5 yr after diagnosis closely reflected ovarian activity as assessed by a range of serum markers, including estradiol, inhibin B, FSH, and anti-müllerian hormone (AMH). Pretreatment serum AMH, FSH, antral follicle count, and age predicted late ovarian activity by univariate analysis. However, only AMH was predictive in a multivariate logistic regression (odds ratio = 13.0; 95% confidence interval = 2.5-66.7); 0.71 ng/ml gave peak likelihood ratio of 7.0 with 54% sensitivity and 92% specificity. Bone mineral density fell over the 4-5 yr after diagnosis with greater loss in women with lower ovarian activity. Higher pretreatment AMH was associated with lower bone mineral density at both lumbar spine and hip at 5 yr (P < 0.02). CONCLUSION: Measurement of AMH at cancer diagnosis predicts long-term ovarian function after chemotherapy. Use of this in clinical practice may allow better prediction of chemotherapy-related risk to future fertility.
Authors: Kathryn J Ruddy; Anne O'Neill; Kathy D Miller; Bryan P Schneider; Emily Baker; Joseph A Sparano; Chau Dang; Donald W Northfelt; George W Sledge; Ann H Partridge Journal: Breast Cancer Res Treat Date: 2014-03-02 Impact factor: 4.872
Authors: Monika L Metzger; Lillian R Meacham; Briana Patterson; Jacqueline S Casillas; Louis S Constine; Nobuko Hijiya; Lisa B Kenney; Marcia Leonard; Barbara A Lockart; Wendy Likes; Daniel M Green Journal: J Clin Oncol Date: 2013-02-04 Impact factor: 44.544
Authors: N L Henry; R Xia; M Banerjee; C Gersch; D McConnell; D Giacherio; A F Schott; M Pearlman; V Stearns; A H Partridge; D F Hayes Journal: Ann Oncol Date: 2013-04-23 Impact factor: 32.976