Ovarian function after cancer treatment in young women affected by Hodgkin disease (HD)

Abstract

We have evaluated the best method to assess the ovarian reserve and the ovarian protective effect of GnRH-analog (GnRH-a), in 29 women with Hodgkin's disease (HD) treated with chemotherapy (CHT). The ovarian reserve was studied by measuring the serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), inhibin B, antimullerian hormone (AMH) and the ultrasound antral follicular count (AFC). The patients were randomly treated with or without GnRH-a. At the time of study menstrual function was normal in 21 cases (72.4%), but absent in 8 (27.5%). Mean basal values of FSH, LH, AMH, inhibin B and AFC were normal in patients less than 30 years old and in the group treated four years or less before observation. AFC appeared to be the best marker of reduced ovarian reserve and a combination of AFC-AMH or inhibin B appeared the best predictor. In the GnRH-a group, no women had amenorrhoea, although ovarian reserve assessment was not significantly different from those who were not treated. The time-interval from CHT was the only significant predictor of ovarian function in GnRH-a treated patients. In conclusion, ovarian reserve evaluation, in young patients treated by CHT, can be performed by AFC. GnRH-a treatment does not have a protective effect, but could delay the development of ovarian failure.

Gonadotropin‐releasing hormone agonists for ovarian protection during cancer chemotherapy: systematic review and meta‐analysis

“…Five studies involved administration of triptorelin intramuscularly [23][24][25][26]35 , one used intranasal buserelin 27 , five used goserelin [28][29][30][31][32] , one administered diphereline 33 and one used leuprolide acetate 34 . In all included studies GnRHa administration was maintained throughout the chemotherapy treatment.…”

“…Nine studies defined as primary outcome the resumption of menses, which is a surrogate for preserved ovarian function [23][24][25][26][27]29,30,32,33 . From these studies we extracted the number of participants that had not resumed menses (i.e.…”

“…The duration of follow-up ranged from 6 months 33 to 7 years 25 . As secondary outcome, nine studies reported the number of participants that became pregnant during the follow-up [23][24][25][26][27][29][30][31]35 . All reported pregnancies resulted from spontaneous (i.e.…”

“…Demeestere (2016) 35 Giuseppe (2007) 24 Waxman (1987) 27 Subtotal (95% CI) Lambertini (2015) 25 Leonard (2017) 30 Moore (2015) 31 Munster (2012) 26 Song (2013) 34 Sverrisdottir (2009) and receptor negative (RR, 0.62; 95% CI, 0.33-1.14) tumors. When all patients were subdivided according to chemotherapy regimen into high toxicity vs low/medium toxicity 6 , the benefit of GnRHa therapy in preventing POI appeared to be of greater magnitude among women treated with low/medium toxicity chemotherapy (RR, 0.49; 95% CI, 0.29-0.84) compared with women treated with highly toxic chemotherapy (RR, 0.66; 95% CI, 0.45-0.96; Figure 4).…”

“…Detection bias might arise if the personnel conducted follow-up surveys or interviews while knowing the patient study group, despite the relative 'objectivity' of the questions asked. Five studies had unclear risk of selection bias because the authors did not provide any information about the randomization process or the allocation concealment 24,27,29,33,34 . Four studies had a high proportion (more than 25%) of participants randomized but not included in the final analysis and were therefore rated as unclear risk of attrition bias [30][31][32]35 .…”