Outcomes of ovarian stimulation after treatment with chemotherapy

Abstract

Purpose Chemotherapeutic agents have a known gonadotoxic effect; however, it is difficult to predict the impact they may have on ovarian stimulation. The objective of this study was to evaluate response to ovarian stimulation in patients exposed to chemotherapy compared with patients who were chemotherapy-naïve. Methods A retrospective cohort study of 130 patients with cancer or autoimmune disease was performed. Demographics, ovarian reserve, ovarian response and stimulation parameters, and oocyte data were compared between patients who were pre-and post-chemotherapy. Logistic regression modeling was performed to identify risk factors for cancellation and low oocyte yield, adjusting for confounders as appropriate. Results Antral follicle count (AFC) was significantly lower in post-chemo patients (9 vs. 17, p<0.001). Post-chemotherapy patients were more likely to be cancelled during stimulation (23 vs. 4 %, p=0.003). Among those that went to retrieval, there was no difference in total number of oocytes (10 vs. 10, p=0.31) or mature oocytes retrieved (8 vs. 8, p=0.38), despite higher starting (300 vs. 450 IU, p<0.001) and total gonadotropin (3075 vs. 4612.5 IU, p=0.008) doses in post-chemotherapy patients. Low AFC (≤6) was associated with cycle cancellation (OR 7.7, 95 % CI 1.8-33.2) and low oocyte yield (<6) (OR 5.4, 95 % CI 1.6-17.7). Conclusions Patients post-chemotherapy have lower AFC compared with the chemotherapy-naïve and have higher cancellation rates. Among those who underwent oocyte retrieval, oocyte yield was similar in both groups. Low AFC was most strongly associated with cycle cancellation and oocyte yield. Post-chemotherapy patients had higher rates of cycle cancellation but did equally well as pre-chemotherapy patients if they reached retrieval.

Fertility preservation in women with malignancies: the accuracy of antral follicle count collected randomly during the menstrual cycle in predicting the number of oocytes retrieved

“…Young women with malignancies are generally counseled on the potential detrimental effects of cancer treatments on future fertility and on the possible benefits of fertility preservation techniques [1][2][3][4][5]. In most cases, this counseling occurs in an urgent setting because delay in the initiation of treatments is generally perceived as potentially detrimental for survival [2] and the techniques for fertility preservation need some time to be done (from days to weeks).…”

iPSC-Derived Ovarian Tissue Restores Ovarian Function in Subfertile Mice and After Gonadotoxic Chemotherapy

“…AMH is exclusively synthesized by granulosa cells during the early stages of follicular development 38 , and AMH serum concentration is an important measure of ovarian reserve 39 . Additionally, the effect of gonadotoxic agents on ovarian follicular development is reflected by lower serum concentrations of AMH 40,41 . Moreover, low AMH levels are prognostic for poor probability of spontaneous conception as well as poor response to ART 42 .…”

In vitrofertilization outcome in women with diminished ovarian reserve

“…Several studies reported a significant decrease in ovarian response to IVF in cancer patients who had undergone chemotherapy [ 9 10 ]. In a cohort study, regardless of the type of cancer, response to gonadotropins and the number of oocytes retrieved were significantly decreased in the post-chemotherapy group [ 10 ]. Our study shows similar results as the previous study of Chan et al [ 10 ].…”

“…In a cohort study, regardless of the type of cancer, response to gonadotropins and the number of oocytes retrieved were significantly decreased in the post-chemotherapy group [ 10 ]. Our study shows similar results as the previous study of Chan et al [ 10 ]. which showed higher cancellation rates in post-chemotherapy patients than in chemotherapy-naïve patients.…”