Is ovarian recovery after chemotherapy in young patients with early breast cancer influenced by controlled ovarian hyperstimulation for fertility preservation or tumor characteristics? Results of a prospective study in 126 patients

Abstract

Young individuals, aged <40 years, represent 7% of all patients with early breast cancer (EBC), most of whom receive chemotherapy. Preserving future fertility in these patients has become a major concern. This prospective study assessed ovarian function during and after chemotherapy according to patient and tumor characteristics and evaluated the outcome of controlled ovarian hyperstimulation (COH).Ovarian reserve was evaluated in terms of amenorrhea duration and by longitudinal serum anti-Müllerian hormone (AMH) level variations measured at study entry, during treatment and until 24 months thereafter. COH has been proposed for patients receiving adjuvant chemotherapy. We studied the association between clinical factors and ovarian function using Cox models and logistic regression. In this young population (age < 38 years, median = 32), 85 of 90 evaluable patients (94%) experienced chemo-induced amenorrhea, including six persistent amenorrhea and one chemotherapy-induced definitive ovarian failure. Overall, 33% of patients still had undetectable AMH values 12 months after the end of chemotherapy, although most had recovered spontaneous and regular menstrual function. No specific factor was associated with clinical or biological late ovarian dysfunction, except for age and baseline AMH value. Overall, 58 patients underwent COH. The mean number of total retrieved oocytes and metaphase II oocytes were of 11.7 and 6.9, respectively. Thus, our study confirms the importance of fertility preservation in young patients with EBC. Our findings indicate that sequential chemotherapy is associated with a higher risk of persistent amenorrhea. There was no significant association between tumor characteristics, fertility preservation or recovery of ovarian reserve.

Giant dysgerminoma with pelvic metastases at the time of puberty: A case report and review of the literature

“…The gold standard for the diagnosis of the tumour is 100% the histopathological study, complemented by immunohistochemical analysis; the expression of the markers OCT3/4, D2-40 and SALL4 are elements of judgement that support the diagnosis of dysgerminoma in any case [18]. Dysgerminomas are generally malignancies with a good prognosis, with a high cure rate, and they are also chemo-and radiosensitive, which allows neoadjuvant protocols to be carried out in the case of giant lesions [19]. Recurrence rates are low.…”

Ovarian reserve in premenopausal women with breast cancer

“…For reasons that are not clear, patients with reproductive history were more likely to develop POI after chemotherapy. There have been previous studies on the types and molecular characteristics of breast cancer and ovarian function after chemotherapy, but the effect of breast cancer stage on ovarian function is rarely mentioned [ [32] , [33] , [34] , [35] ]. We found that compared with patients with pathological stage Ⅱ or Ⅲ disease, patients with stage Ⅰ disease had a lower risk of POI and were more likely to recover from temporary impairment of ovarian function, which may be related to systemic changes in the natural course of breast cancer, suggesting that patients with earlier stages of disease have better body function, including ovarian function.…”

Efficacy and safety of controlled ovarian hyperstimulation with or without letrozole for fertility preservation in breast cancer patients: A multicenter retrospective study

“…AMH measures were performed using the Roche Elecsys AMH Plus assay in both centers with a limit of detection (LOD) of 0.01 ng/ml. without letrozole, before administration of chemotherapy in an adjuvant setting (cCOH) [19].…”

“…All as recommended for standard COH protocol [13]. In the cCOH group, ovulation triggering was performed with GnRHa (0.2 mg), hCG (6,500 IU) or dual trigger (GnRHa 0.2mg and hCG 1,500 IU) 7 mm and a majority of intermediary , based on standard practice [19].…”