Female cancer survivors exposed to alkylating-agent chemotherapy have unique reproductive hormone profiles

Women exposed to alkylating-agent chemotherapy have a unique reproductive hormone profile that is not solely explained by age or ovarian reserve.

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Volume 106, Issue 7, Pages 1793-1799

Authors:

Lauren Johnson, M.D., M.S.C.E., Mary D. Sammel, Sc.D., Allison Schanne, B.A., Lara Lechtenberg, B.A., Maureen Prewitt, B.S.N., Clarisa Gracia, M.D., M.S.C.E.

Abstract:

Objective

To evaluate reproductive hormone patterns in women exposed to alkylating-agent chemotherapy.

Design

Prospective cohort.

Setting

University hospital.

Patient(s)

Normally menstruating mid-reproductive-age women (20–35 years old) who had previously been exposed to alkylating-agent chemotherapy for cancer treatment were compared with two healthy control populations: similarly-aged women and late-reproductive-age women (43–50 years old).

Intervention(s)

Subjects collected daily urine samples for one cycle.

Main Outcome Measure(s)

Integrated urinary pregnanediol glucuronide (PDG) and estrone conjugate (E1c) and urinary excretion of gonadotropins (FSH and LH).

Result(s)

Thirty-eight women (13 survivors, 11 same-age control subjects, 14 late-reproductive-age control subjects) provided 1,082 urine samples. Cycle length, luteal phase length, and evidence of luteal activity were similar among the groups. As expected, ovarian reserve was impaired in cancer survivors compared with same-age control subjects but similar between survivors and late-reproductive-age control subjects. In contrast, survivors had total and peak PDG levels that were similar to same-age control subjects and higher than those observed in late-reproductive-age control subjects. Survivors had higher E1c levels than both same-age and late-reproductive-age control subjects. There was no difference in urinary gonadotropins among the groups.

Conclusion(s)

Women exposed to alkylating agents have a unique reproductive hormone milieu that is not solely explained by age or ovarian reserve. The urinary hormone profile observed in survivors appears more similar to same-age control subjects than to late-reproductive-age women with similar ovarian reserve, which may suggest that age plays a more important role than ovarian reserve in the follicular dynamics of survivors.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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