Catarina Policiano1, Jessica Subirá2,3, Alejandra Aguilar4, Susana Monzó4, Ignacio Iniesta4, Jose María Rubio Rubio4. 1. Department of Obstetrics and Gynecology, CHLN-Hospital Universitário de Santa Maria, Lisbon, Portugal. 2. Accredited Group on Reproductive Medicine, Institute of Health Investigation La Fe, University Hospital La Fe, Valencia, Spain. jessica.subira@ivirma.com. 3. IVI-Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain. jessica.subira@ivirma.com. 4. Accredited Group on Reproductive Medicine, Institute of Health Investigation La Fe, University Hospital La Fe, Valencia, Spain.
Abstract
RESEARCH QUESTION: How is ovarian reserve affected by chemotherapy in patients with Hodgkin lymphoma (HL) who undergo fertility preservation (FP)? METHODS: A retrospective study was conducted by reviewing medical records of 105 HL patients referred to the FP unit before starting adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. Ovarian reserve was evaluated before chemotherapy and at the last follow-up using anti-Müllerian hormone (AMH) and antral follicle count (AFC) measurements. The decrease in AMH was compared with that expected from normograms. AMH was compared between patients who underwent cryopreservation of ovarian tissue and those who underwent cryopreservation of mature oocytes. RESULTS: After ABVD, 15% of patients required hematopoietic stem cell transplantation. At a median follow-up of 33 months, the median decrease in AMH was 0.88 ng/mL, which was significantly greater than that of the general population of this age group (p < 0.001). Of the 82 women who only had ABVD, 38 underwent FP by cryopreservation of mature oocytes and 44 underwent cryopreservation of the ovarian cortex. There was no significant difference in AMH or AFC at the last follow-up between FP techniques. CONCLUSION: Although ABVD is considered to be of low gonadotoxic risk, the decrease in AMH was greater than expected for patients' age, and 15% of patients needed more aggressive therapy during follow-up. Type of FP was not associated with decline in ovarian reserve. Reproductive-aged women with HL should have the opportunity for FP counseling before starting treatment.
RESEARCH QUESTION: How is ovarian reserve affected by chemotherapy in patients with Hodgkin lymphoma (HL) who undergo fertility preservation (FP)? METHODS: A retrospective study was conducted by reviewing medical records of 105 HL patients referred to the FP unit before starting adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. Ovarian reserve was evaluated before chemotherapy and at the last follow-up using anti-Müllerian hormone (AMH) and antral follicle count (AFC) measurements. The decrease in AMH was compared with that expected from normograms. AMH was compared between patients who underwent cryopreservation of ovarian tissue and those who underwent cryopreservation of mature oocytes. RESULTS: After ABVD, 15% of patients required hematopoietic stem cell transplantation. At a median follow-up of 33 months, the median decrease in AMH was 0.88 ng/mL, which was significantly greater than that of the general population of this age group (p < 0.001). Of the 82 women who only had ABVD, 38 underwent FP by cryopreservation of mature oocytes and 44 underwent cryopreservation of the ovarian cortex. There was no significant difference in AMH or AFC at the last follow-up between FP techniques. CONCLUSION: Although ABVD is considered to be of low gonadotoxic risk, the decrease in AMH was greater than expected for patients' age, and 15% of patients needed more aggressive therapy during follow-up. Type of FP was not associated with decline in ovarian reserve. Reproductive-aged women with HL should have the opportunity for FP counseling before starting treatment.
Authors: R Imbert; F Moffa; S Tsepelidis; P Simon; A Delbaere; F Devreker; J Dechene; A Ferster; I Veys; M Fastrez; Y Englert; I Demeestere Journal: Hum Reprod Date: 2014-06-22 Impact factor: 6.918
Authors: Alexander Shimabukuro-Vornhagen; Heinz Haverkamp; Andreas Engert; Leopold Balleisen; Peter Majunke; Günther Heil; Hans Theodor Eich; Harald Stein; Volker Diehl; Andreas Josting Journal: J Clin Oncol Date: 2005-07-11 Impact factor: 44.544
Authors: David B Duggan; Gina R Petroni; Jeffrey L Johnson; John H Glick; Richard I Fisher; Joseph M Connors; George P Canellos; Bruce A Peterson Journal: J Clin Oncol Date: 2003-02-15 Impact factor: 44.544
Authors: V Diehl; M Sextro; J Franklin; M L Hansmann; N Harris; E Jaffe; S Poppema; M Harris; K Franssila; J van Krieken; T Marafioti; I Anagnostopoulos; H Stein Journal: J Clin Oncol Date: 1999-03 Impact factor: 44.544
Authors: Volker Diehl; Jeremy Franklin; Michael Pfreundschuh; Bernd Lathan; Ursula Paulus; Dirk Hasenclever; Hans Tesch; Richard Herrmann; Bernd Dörken; Hans-Konrad Müller-Hermelink; Eckhardt Dühmke; Markus Loeffler Journal: N Engl J Med Date: 2003-06-12 Impact factor: 91.245
Authors: Richard A Anderson; Rachel Remedios; Amy A Kirkwood; Pip Patrick; Linsey Stevens; Laura Clifton-Hadley; Tom Roberts; Chris Hatton; Nagesh Kalakonda; Don W Milligan; Pam McKay; Clare Rowntree; Fiona M Scott; Peter W M Johnson Journal: Lancet Oncol Date: 2018-09-13 Impact factor: 54.433
Authors: Ashley A Diaz; Hana Kubo; Nicole Handa; Maria Hanna; Monica M Laronda Journal: Front Endocrinol (Lausanne) Date: 2022-06-10 Impact factor: 6.055