Effects of chemotherapy upon fertility amongst women of reproductive age, using AMH as a marker of ovarian reserve

Doctoral thesis English OPEN
Palinska-Rudzka, Karolina
  • Subject: RC0254 | R1
    mesheuropmc: endocrine system

Nowadays, early detection of cancer and improving survival rates mean that more young women diagnosed with cancer have a normal life expectancy. For many of them the ability to conceive after successful treatment is one of their prime concerns. This dissertation evaluated the adverse effects upon fertility of some of the most common chemotherapeutic regimens used for cancers affecting women of reproductive age. Serial serum anti-Müllerian hormone(AMH) measurements were used to assess ovarian function in female patients with breast cancer or lymphoma before chemotherapy and compared longitudinally with same age healthy volunteers. Interestingly, women experiencing cancer during their reproductive years had a significantly lower ovarian reserve than healthy women, even before the start of chemotherapy. Overall 35% of reproductive age women newly diagnosed with cancer still expressed some desire to have children, while the same was true for nearly 50% of women aged =39 years. Simultaneously, only 9% of them had had a consultation with a fertility specialist regarding fertility preservation options or the impact of chemotherapy on ovarian function. Oncologists should consider women’s wishes regarding fertility while counselling patients prior to cancer therapy. Overall in the cancer group, AMH declined significantly from the prechemotherapy level, remaining undetectable in 80% of patients within the first 12 months. It confirmed devastating effects of some of the chemotherapeutic agents on ovarian reserve. In the breast cancer group, only 15% of women had detectable AMH at 12 month follow-up. In contrast, amongst patients with Hodgkin lymphoma, more than 60% had a detectable degree of recovery of AMH concentrations at 12 months of follow-up, which was even higher if only ABVD regimen was used in women aged = 32. Nearly 90% of those women reported the resumption of menstruation. My study offers reliable statistics as well as formulae calculating the probability of return of menses that can be used by oncology teams during consultations prior to chemotherapy. In contrast to other published results, I concluded that pre-treatment serum AMH concentrations are not correlated with amenorrhea or post-treatment AMH concentrations. However, AMH in combination with age could be used to calculate the risk of amenorrhea at 12 months using a prediction model constructed as a result of my work. In light of the recent debate about the reliability of AMH assays, my results confirmed the intra-subject reproducibility of the second generation AMH assay, providing evidence that is eagerly awaited by clinicians working in the field of Reproductive Medicine. My study supports the reliability of AMH measurements at unspecified times of the menstrual cycle. It provides guidance and reassurance to doctors using AMH assay in clinical practice.
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