Effect of First Line Cancer Treatment on the Ovarian Reserve and Follicular Density in Girls Under the Age of 18 Years

Abstract

Objective: To study the impact of first-line antineoplastic treatment on ovarian reserve in young girls returning for ovarian tissue cryopreservation (OTC) in connection with a relapse. Design: Retrospective case-control study. Setting: University hospitals. Patient(s): Sixty-three girls under the age of 18 years who underwent OTC before (group 1: 31 patients) and after (group 2: 32 patients) their initial cancer treatment. Intervention(s): None. Main Outcome Measure(s): Follicular densities (follicles/mm 3 ) measured from an ovarian cortical biopsy before OTC. The ovarian volume (mL) of entire ovaries excised for OTC was also monitored. Result(s): There was no statistically significant difference in the mean age or follicular density between groups 1 and 2 (334 AE 476/ mm 3 vs. 327 AE 756/mm 3 ). In contrast, the ovarian volume and total number of ovarian cortex chips cryopreserved were statistically significantly lower in patients who received gonadotoxic treatment before OTC (mean AE standard deviation [SD]: ovarian volume, 5.3 AE 3.1 mL vs. 2.9 AE 2.1 mL, respectively; number of cortex chips: 21.3 AE 8.1 vs. 15.2 AE 7.1, respectively). The reduction in the estimated ovarian reserve ranged from 10% to 20% in children to around 30% in adolescent girls (>10 years). Conclusion(s): Girls under the age of 10 tolerate a gonadotoxic insult better than adolescents, who may experience up to a 30% reduction in the ovarian reserve via first-line gonadotoxic treatment, which at present is considered to have little effect on the follicle pool. This information will improve counseling of young female cancer patients in deciding whether to undergo fertility preservation treatment. (Fertil Steril Ò 2016;106:1757-62.

Characterization of follicles in girls and young women with Turner syndrome who underwent ovarian tissue cryopreservation

“…All patients underwent OTC between the years 2002 and 2016. Follicle densities in the control girls with cancer below tha age of 18 years has previously been published (11). One additional ovarian biopsy from a girl with Fanconi anemia was included for immunohistochemical (IHC) staining.…”

Cryopreservation of ovarian tissue may be considered in young girls with galactosemia

“…Patients A total of 6 pre-pubertal girls below the age of 12 (mean age 3.8 years ± 1.7 (± SEM); range, 0.4-11.7 years) diagnosed with galactosemia had one entire ovary surgically removed by laparoscopy and OTC for fertility preservation at the Laboratory of Reproductive Biology, Rigshospitalet, Denmark. The control group consisted of 31 girls below the age of 18 years (mean age 13.5 years ± 0.7 (± SEM); range, 1.5-17.9 years) diagnosed with a malignant disease, who had one ovary removed for OTC and fertility preservation prior to gonadotoxic treatment [21]. Controls underwent an identical surgical procedure and cryopreservation program at the same department as the girls with galactosemia.…”

FertiPROTEKT, Oncofertility Consortium and the Danish Fertility-Preservation Networks – What Can We Learn From Their Experiences?

“…• Rosendahl et al 38 • Rosendahl et al 39 • Andersen et al 10 • Greve et al 40 • Greve et al 40 • Dolmans et al 41 • Ernst et al 42 • Sørensen et al 43 • Andersen et al 44 • El Issaoui et al 45 • In vitro maturation • Wilken-Jensen et al 46 • Yin et al 47 • Gruhn et al 48 • Transplant tissue to restore reproductive and/or endocrine function…”