Antral follicle count recovery in women with menses after treatment with and without gonadotropin-releasing hormone agonist use during chemotherapy for breast cancer

• Published in: Journal of assisted reproduction and genetics Vol. 35; no. 10; pp. 1861 - 1868
• Main Authors: Sinha, N., Letourneau, J. M., Wald, K., Xiong, P., Imbar, Tal, Li, B., Harris, E., Mok-Lin, E., Cedars, M. I., Rosen, Mitchell P.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-10-2018; Springer Nature B.V
• Subjects: Adult; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - physiopathology; Cancer therapies; Chemotherapy; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Female; Fertility; Fertility Preservation; Fertility Preservation - methods; Follicular Fluid - drug effects; Follicular Fluid - metabolism; Follicular Fluid - physiology; Gonadotropin-releasing hormone; Gonadotropin-Releasing Hormone - administration & dosage; Gonadotropin-Releasing Hormone - metabolism; Gonadotropins; Gynecology; Human Genetics; Humans; Medicine; Medicine & Public Health; Oocytes - drug effects; Oocytes - growth & development; Oocytes - metabolism; Ovarian Follicle - drug effects; Ovarian Follicle - growth & development; Ovarian Follicle - metabolism; Ovarian Follicle - physiopathology; Patients; Pituitary (anterior); Preservation; Reproductive Medicine; Reproductive status; Tamoxifen; Tamoxifen - administration & dosage; Tamoxifen - adverse effects; Ovarian suppression; Antral follicle count; Chemotherapy; Breast cancer; Fertility preservation; Ovarian reserve
• ISSN: 1058-0468; 1573-7330
• DOI: 10.1007/s10815-018-1203-8

Purpose
After chemotherapy for breast cancer, most women will recover some ovarian function, but the timing and extent of this recovery are poorly understood. We studied post-chemotherapy ovarian recovery in women with and without a history of ovarian suppression during chemotherapy.
Methods
Reproductive age breast cancer patients who were seen prior to chemotherapy for fertility preservation consult were consented for follow-up ovarian function assessment (every 3–6 months after chemotherapy) with antral follicle count (AFC) in this prospective cohort study. We restricted our analysis to those with menses present after chemotherapy. Box plots were used to demonstrate the change in follow-up AFC versus time elapsed after chemotherapy. A mixed effects regression model was used to assess differences in AFC.
Results
Eighty-eight patients with a history of newly diagnosed breast cancer were included. Forty-five patients (51%) had ovarian suppression with GnRH agonist (GnRHa) during chemotherapy. AFC recovery appeared to plateau at 1 year after completing chemotherapy at a median of 40% of pre-chemotherapy AFC. After adjustment for age, initial AFC, cyclophosphamide exposure, combined hormonal contraceptive (CHC) use, and tamoxifen use, AFC recovered faster and to a greater degree for those women who underwent GnRHa therapy for ovarian protection during chemotherapy (
P
 = 0.032).
Conclusions
Women with menses after chemotherapy for breast cancer appear to recover their full potential AFC 1 year after their last chemotherapy dose. Treatment with GnRHa during chemotherapy is associated with a higher degree of AFC recovery. The findings of this study can aid in counseling patients prior to chemotherapy about expectations for ovarian recovery and planning post-treatment fertility preservation care to maximize reproductive potential when pre-treatment fertility preservation care is not possible or has limited oocyte yield.