Spontaneous recovery of chemotherapy‐induced primary ovarian failure: implications for management

Abstract

A 14-year-old female patient presented with a swelling, which was excised, over the left forearm. Histology revealed a poorly differentiated rhabdomyosarcoma and she was treated with multiple chemotherapy for 2 years, including cyclophosphamide, cisplatin and vincristine. She developed secondary amenorrhoea shortly after commencing treatment which persisted on its completion. Biochemical investigations were consistent with ovarian failure, which was assumed to be chemotherapy-induced and permanent. She was given hormone replacement with a conjugated equine oestrogen/norgestrel combination, resulting in regular withdrawal bleeding. At 22 years of age; she presented with amenorrhoea for 3 months. Investigations revealed FSH 2.7 IU/l, LH > 50 IU/l and oestradiol > 1320 pmol/l. A pregnancy test was positive and subsequent ultrasound scanning confirmed the presence of a foetus of 18 weeks gestation. The patient initially considered a termination as she had been unprepared for this event but later elected to continue the pregnancy which proceeded uneventfully and resulted in the birth of a normal infant. Ovarian function should be reassessed periodically in patients with chemotherapy-induced gonadal damage and/or the oral contraceptive pill should be used as hormone replacement unless fertility is desired.

Gonadal function in young patients successfully treated for Hodgkin disease

“…Recovery of ovarian function may occur many years following treatment with chemotherapy [36]. In the present study, we have documented reversal of ovarian failure in four of seven patients with abnormally elevated FSH/LH.…”

Endocrine complications in long-term survivors of childhood cancers

“…Histologic examination of ovarian tissue in prepubertal and postpubertal girls treated for solid tumors or leukemia has nevertheless revealed a decreased number of ovarian follicles and inhibition of follicular growth compared with age-matched controls (HimelsteinBraw et al 1978, Larsen et al 2003. Thus, it is not surprising that among women who do retain or recover function following treatment with standard doses of alkylating agents, a subset will experience premature menopause when they reach their 20s and 30s (Byrne et al 1992, Nasir et al 1997, Papadakis et al 1999, Sklar 1999.…”

Reproductive Toxic Effects of Cisplatin and Its Modulation by the Antioxidant Sodium 2-Mercaptoethanesulfonate (Mesna) in Female Rats

“…Studies have shown that women who have undergone cisplatin chemotherapy either intravenously or intraperitoneally were able to become pregnant spontaneously while other females failed to conceive. [2][3][4] In some pregnancies following cisplatin administration, spontaneous abortions have been reported. 4 Cisplatin treatment during pregnancy in humans has been demonstrated to have very few to no known effects on fetuses in postnatal or early life.…”