Effect of first line cancer treatment on the ovarian reserve and follicular density in girls under the age of 18 years
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Objective: To study the impact of first-line antineoplastic treatment on the ovarian reserve in young girls returning for ovarian tissue cryopreservation (OTC) in connection with a relapse. Design: Retrospective case-control study. Setting: University hospitals. Patients: 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/mm3) 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 ± 476/mm3 vs. 327 ± 756/mm3). 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 ± standard deviation [SD]: ovarian volume, 5.3 ± 3.1 mL vs. 2.9 ± 2.1 mL, respectively; number of cortex chips: 21.3 ± 8.1 vs. 15.2 ± 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.
El Issaoui , M , Giorgine , V , Mamsen , L S , Rechnitzer , C , Birkebæk , N , Clausen , N , Kelsey , T W & Andersen , C Y 2016 , ' Effect of first line cancer treatment on the ovarian reserve and follicular density in girls under the age of 18 years ' Fertility and Sterility , vol 106 , no. 7 , pp. 1757–1762.e1 . DOI: 10.1016/j.fertnstert.2016.09.001
Fertility and Sterility
© 2016, American Society for Reproductive Medicine. This work is made available online in accordance with the publisher’s policies. This is the author created, accepted version manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at www.fertstert.org / http://dx.doi.org/10.1016/j.fertnstert.2016.09.002
The Child Cancer Foundation in Denmark, The Novo Nordisk Foundation and the EU interregional project ReproHigh/ReproUnion are thanked for having funded this study.
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