Impact of cancer treatment on risk of infertility and diminished ovarian reserve in women with polycystic ovary syndrome

Cancer survivors with polycystic ovary syndrome had higher ovarian reserve but were less likely to meet their reproductive goals compared with survivors without polycystic ovary syndrome.

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Volume 109, Issue 3, Pages 516–525.e1

Authors:

Lisa M. Shandley, M.D., M.Sc., Amy Fothergill, M.P.H., Jessica B. Spencer, M.D., M.Sc., Ann C. Mertens, Ph.D., Hanh N. Cottrell, M.D., Penelope P. Howards, Ph.D.

Abstract:

Objective

To compare markers of fertility and ovarian reserve between cancer survivors and cancer-free women with and without polycystic ovary syndrome (PCOS).

Design

Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women's Study—a population-based cohort study.

Setting

Not applicable.

Patient(s)

Female cancer survivors (n = 1,090) aged 22–45 years, diagnosed between ages 20 and 35 years, and at least 2 years after diagnosis; 369 participated in a clinic visit. Three hundred seventy-four reproductive-aged women without cancer also completed a clinic visit.

Intervention(s)

None.

Main Outcome Measure(s)

Infertility, time to first pregnancy after cancer diagnosis, and measures of ovarian reserve (antimüllerian hormone [AMH] and antral follicle count [AFC]).

Results

Seventy-eight cancer survivors (7.2%) reported a PCOS diagnosis, with 41 receiving gonadotoxic treatment. Survivors with PCOS exposed to gonadotoxic treatment (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.2–4.5) and unexposed (OR 3.4, 95% CI 1.7–6.9) were more likely to report infertility than unexposed survivors without PCOS and were more likely to have fewer children than desired (exposed: OR 2.1, 95% CI 1.0–4.2; unexposed: OR 3.0, 95% CI 1.4–6.8). After adjusting for age, comparison women with PCOS had the highest markers of ovarian reserve (AMH: 2.43 ng/mL, 95% CI 1.22–4.82 ng/mL; AFC: 20.7, 95% CI 15.3–27.8), and cancer survivors without PCOS treated with gonadotoxic agents had the lowest levels (AMH: 0.19 ng/mL, 95% CI 0.14–0.26 ng/mL; AFC: 7.4, 95% CI 6.4–8.5).

Conclusion(s)

Despite having higher AMH and AFC on average after cancer treatment, cancer survivors with PCOS were less likely to meet their reproductive goals compared with survivors without PCOS.


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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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