Ovarian Function in Female Survivors of Childhood Malignancies

Abstract

Female survivors of childhood malignancies had reduced ovarian reserve and reduced mean ovarian volume, especially those with older age, older age of menarche, and longer treatment duration.

Endocrinopathies in Survivors of Childhood Neoplasia

“…A study of an AML cohort treated with chemotherapy alone (anthracyclines and cytarabine) demonstrated that menarche occurred at the mean age of 13.1 years and fertility rates were similar to their siblings (92). Even in the absence of exposure to API and despite the occurrence of menarche at a normal age, CCS were nevertheless shown to have a decreased reproductive capacity in comparison to healthy controls in another report (113). The risk of premature menopause was 8 and 0.8% (RR = 13.21, 95% CI = 3.26–53.51; p  < 0.001) in CCS and siblings, respectively (108).…”

“…Cancer treatments associated with ovarian toxicity include abdominopelvic irradiation (API) and chemotherapy agents such as cyclophosphamide, procarbazine, busulfan, melphalan, and thiotepa (107–110). Chemotherapy is less toxic to the ovaries of pre-pubertal females in comparison to pubertal and adult females (107, 111–113). The ovarian toxicity of API is age and dose dependent, irradiation doses >20 Gy in female, CCS >13 years old, and TBI in CCS > 10-years is correlated with ovarian insufficiency (107, 114, 115).…”

“…The cumulative incidence of premature menopause was highest among CCS exposed to both alkylating agents and API (108). Evidence of ovarian insufficiency includes elevated gonadotropins, low anti-mullerian hormone (AMH) levels, and reduced mean ovarian volume (113). AMH is an acceptable marker of ovarian follicular reserve in female CCS, and low levels are indicative of declining ovarian function (116–119).…”

Fertility Preservation Options for Women Treated for Cancer

“…the fertility of young female cancer survivors because it causes irreversible premature ovarian insuffi ciency, which is defi ned as menopause before the age of 40 (El-Shalakany, Ali, Abdelmaksoud, El-Ghany, & Hasan, 2013). Th ere are very few chemotherapeutic agents that are capable of cell specifi city, but the alkylating agents have demonstrated the highest levels of gonadotoxicity.…”

“…This process is particularly devastating to ovarian cells because after destruction they are not capable of regeneration (Bedaiwy et al, ). The attack on female reproductive cells can have a large impact on the fertility of young female cancer survivors because it causes irreversible premature ovarian insufficiency, which is defined as menopause before the age of 40 (El‐Shalakany, Ali, Abdelmaksoud, El‐Ghany, & Hasan, ). There are very few chemotherapeutic agents that are capable of cell specificity, but the alkylating agents have demonstrated the highest levels of gonadotoxicity.…”