Women with ovarian function after breast cancer recover half of their antral follicle count 1 year after exposure to Cytoxan-based chemotherapy

e14098 Background: Premature ovarian failure (POF) is an established adverse effect of chemotherapy for breast cancer (BC); little is known about the ovarian toxicity of newer treatments (e.g. PARPi, CDK4/6 inhibitors, immunotherapy, anti-HER2 therapy). This study examined whether contemporary BC (neo)adjuvant clinical trials will provide data on POF. Methods: Eligible studies were phase 3 (neo)adjuvant trials of pharmacologic agents aimed to reduce BC events, that enrolled premenopausal women between June 2008 - Sept 2019. MEDLINE and EMBASE were searched using MESH terms / keywords: “breast neoplasm” or “breast adj2 (cancer* or tumo?r* or carcinoma*)”, “adjuvant chemotherapy” or “neoadjuvant therapy” or “neoadjuvant” or “adjuvant”. Clinicaltrials.gov and EudraCT were searched using the filters “breast cancer”, “interventional studies”, “phase 3”. Data extracted from eligible trial publications, protocols and clinicaltrials.gov/EudraCT summaries, included whether each trial assessed the variables - post treatment pregnancy/birth, attempt at pregnancy, menstrual data, antral follicle count, FSH, LH, estrogen, progesterone and AMH levels. Results: Of 1665 trials screened, 141 were eligible. Investigational treatments included chemotherapy (71%), endocrine (20%), anti-HER2 (26%), immunotherapy (8%), CDK4/6 inhibitor (5%), PARPi (2%). Few trials (28%) assessed quality of life (QOL). Study chairs were from Nth America (19%), Europe (36%), Asia (43%); most (67%) were male. POF and fertility measures were prespecified endpoints in 9 (6%) and 0 trials respectively. Twenty (14%) trials collected POF and/or fertility data; post treatment pregnancy (11/20), amenorrhoea (6/20), estrogen (8/20), FSH (7/20), LH (5/20), AMH (3/20), and progesterone levels (1/20) and antral follicle count (3/20). Assessment of POF was associated with collection of QOL data (p = 0.02) but not with BC phenotype, timing, treatment type, or sex or nationality of study chair. Conclusions: POF measures are rarely prespecified endpoints and are infrequently collected in phase 3 BC (neo)adjuvant trials. Trialists should consider POF, given the potential for this data to enhance informed decision making for premenopausal patients.

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Higher antral follicle count associated with earlier return of ovarian function in breast cancer patients with temporary amenorrhea after chemotherapy

Fertility and Sterility ◽

10.1016/j.fertnstert.2017.02.046 ◽

2017 ◽

Vol 107 (3) ◽

pp. e26

Author(s):

Nikita Sinha ◽

Joseph Letourneau ◽

Julia Kim ◽

Mitchell Rosen

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Ovarian Function ◽

Antral Follicle ◽

Antral Follicle Count ◽

Breast Cancer Patients

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Antral follicle count provides additive information to hormone measures for determining ovarian function in breast cancer survivors

Fertility and Sterility ◽

10.1016/j.fertnstert.2010.12.005 ◽

2011 ◽

Vol 95 (5) ◽

pp. 1857-1859 ◽

Cited By ~ 9

Author(s):

H. Irene Su ◽

Karine Chung ◽

Mary D. Sammel ◽

Clarisa R. Gracia ◽

Angela DeMichele

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Ovarian Function ◽

Antral Follicle ◽

Antral Follicle Count

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Prediction of ovarian aging using ovarian expression of BMP15, GDF9, and C-KIT

Experimental Biology and Medicine ◽

10.1177/1535370220915826 ◽

2020 ◽

Vol 245 (8) ◽

pp. 711-719

Author(s):

Min Jung Park ◽

Jun-Woo Ahn ◽

Ki Hyung Kim ◽

Junghee Bang ◽

Seung Chul Kim ◽

...

Keyword(s):

Embryo Development ◽

Ovarian Function ◽

Antral Follicle ◽

Antral Follicle Count ◽

Development Rate ◽

Ovarian Aging ◽

Age Related ◽

Morphogenetic Protein ◽

New Information ◽

Potential Biomarkers

This study investigated ovarian expressions of bone morphogenetic protein 15 (BMP15), growth differentiation factor 9 (GDF9), and C-KIT according to age in female mice to determine whether these factors can be served as new potential biomarkers of ovarian aging. Ovaries were collected from mice aged 10, 20, 30, and 40 weeks, and ovarian expressions of BMP15, GDF9, and C-KIT were examined by real-time PCR, Western blot, and immunohistochemistry. Follicle counts were measured on histological hematoxylin and eosin staining. In the second experiment to evaluate ovarian function, after superovulation with PMSG and hCG, the numbers of zygotes retrieved and embryo development rate were examined. Ovarian expressions of BMP15, GDF9, and C-KIT decreased with age. Follicle counts, numbers of retrieved zygotes, and embryo development rate were also significantly reduced in old mice over 30 weeks compared with young mice. These results indicate that these factors could be served as new potential biomarkers of ovarian aging. Impact statement Ovarian aging is becoming a more important issue in terms of fertility preservation and infertility treatment. Serum anti-Mullerian hormone (AMH) level and antral follicle count (AFC) are being practically used as markers of ovarian aging as well as ovarian reserve in human. However, these factors have some drawbacks in assessing ovarian aging and reserve. Therefore, the identification of ovarian expressions of BMP15, GDF9, and C-KIT according to female could be applied as a potent predictor of ovarian aging. This work provides new information on the development of diagnosis and treatment strategy of age-related fertility decline and premature ovarian insufficiency.

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Antral follicle count predicts menstrual function after chemotherapy in breast cancer patients

Fertility and Sterility ◽

10.1016/j.fertnstert.2017.07.547 ◽

2017 ◽

Vol 108 (3) ◽

pp. e184

Author(s):

N. Sinha ◽

J. Letourneau ◽

P. Xiong ◽

E. Harris ◽

E. Gomes ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Antral Follicle ◽

Antral Follicle Count ◽

Breast Cancer Patients ◽

Menstrual Function

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Ovarian reserve in patients who have undergone endometriosis surgery

Vojnosanitetski pregled ◽

10.2298/vsp160408363d ◽

2018 ◽

Vol 75 (7) ◽

pp. 644-650

Author(s):

Olivera Dzatic-Smiljkovic ◽

Mladenko Vasiljevic ◽

Ivana Rudic ◽

Jelena Vugdelic ◽

Aleksandar Ristic ◽

...

Keyword(s):

Ovarian Reserve ◽

Ovarian Function ◽

Uterine Cavity ◽

Antral Follicle ◽

Antral Follicle Count ◽

Inhibin B ◽

Ca 125 ◽

Control Group ◽

Study Group ◽

Ovarian Volume

Background/Aim. Endometriosis is a gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. The aim of this paper was to determine the effect of laparoscopic cystotomy and cystectomy on ovarian function, as well as to compare these two methods in terms of qualitative and quantitative damage to the ovaries, achieved pregnancies and recurrence. Methods. The prospective study, conducted in ?Narodni Front? Obstetrics and Gynaecology Clinic in Belgrade at the Endoscopic Infertility Treatment Ward, included a total of 150 patients. The study group was represented by 100 patients who underwent a surgical treatment of endometrial ovarian cysts. The patients in the study group were divided into 2 subgroups: Subgroup I consisted of 50 patients who underwent a laparoscopic cystotomy (incision of the cyst and thermal coagulation) and subgroup II which included 50 women who underwent a laparoscopic cystectomy. The control group consised of patients who underwent a surgery due to tubal factor infertility. The following parameters of the ovarian function were tested: the ovarian volume, the antral follicle count, the presence of the preovulatory follicle on the operated ovary, the serum levels of anti- M?llerian hormone (AMH), follicle-stimulating hormone (FSH), ovarian tumor marker (Ca 125), inhibin B, as well as the rate of achieved pregnancies one year after the surgery. Results. The ovarian volume and the antral follicle count as well as the FSH values were significantly higher in the control group in comparison with the patients in the study group. There were no significant differences in the ovarian volume, the antral follicle count, the AMH values and inhibin B values in the study group between the patients with cystectomy and those with the incision and coagulation of the cyst. Conclusion. Both surgical techniques diminished the ovarian reserve: cystectomy was more aggressive method in terms of the damage inflicted on the ovarian tissue, and incision with coagulation carried a higher risk of recurrence.

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Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus

Journal of Family & Reproductive Health ◽

10.18502/jfrh.v15i1.6076 ◽

2021 ◽

Author(s):

Felipe Arturo Morales-Martínez ◽

Celina Salas-Castro ◽

Manuel Rolando. García-Garza ◽

Otto Valdés-Martínez ◽

Selene Marysol García-Luna ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Ovarian Reserve ◽

Lupus Erythematosus ◽

Ovarian Function ◽

Autoimmune Disorder ◽

Antral Follicle ◽

Antral Follicle Count ◽

Pharmacological Treatments ◽

Systemic Lupus ◽

Normal Individuals

Objective: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder where the disease activity itself and the medications used for its treatment, may have adverse effects on ovarian function. This study aimed to assess the ovarian reserve (OR) in SLE patients. Materials and methods: The anti-müllerian hormone (AMH) and the antral follicle count (AFC), two markers to evaluate the OR was assessed in 64 SLE patients and compared to normal individuals. Additionally, we assessed whether the disease per se or the pharmacological treatments affect the OR. Results: Patients with SLE displayed alterations in the OR regardless of the presence of alterations of the menstrual cycle. The AFC and AMH were significantly lower in SLE patients with and without menstrual alterations when compared to control individuals (p<0.0001). However, the AFC and AMH levels were significantly correlated (p=0.006) in the SLE patients with menstrual alterations. Except for hydroxychloroquine that was statistically higher in SLE patients with menstrual alterations (p=0.04), the cumulative dose for cyclophosphamide, corticosteroid, and methotrexate was similar in SLE patients regardless of the occurrence of menstrual alterations. Conclusion: The monitoring of AMH and AFC in SLE patients should be used to detect the rapid and irreversible decline of the OR to provide a possibility of pregnancy to the SLE patients.

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Urinary Bisphenol A Concentrations and Parameters of Ovarian Reserve among Women from A Fertility Clinic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158041 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8041

Author(s):

Ewelina Czubacka ◽

Bartosz Wielgomas ◽

Anna Klimowska ◽

Michał Radwan ◽

Paweł Radwan ◽

...

Keyword(s):

Bisphenol A ◽

Ovarian Reserve ◽

Animal Studies ◽

Ovarian Function ◽

Ion Trap ◽

Antral Follicle ◽

Antral Follicle Count ◽

Fertilization Rate ◽

Reproductive Age ◽

Study Participants

Background: Human exposure to environmentally widespread endocrine disruptors, especially bisphenol A (BPA), has been suggested to affect reproductive health. Animal studies indicate that BPA may play a role in the process of reproduction and impact on maturing oocytes, meiotic cell division or fertilization rate. Nevertheless, data regarding the effects of exposure to BPA on women’s ovarian function are still limited. Therefore, the aim of the current study is to assess the effects of environmental exposure to BPA on ovarian reserve. Methods: The study participants consisted of 511 women in reproductive age (25–39 years) who attended an infertility clinic for diagnosis, due to the couples’ infertility. BPA urinary concentrations were assessed by the validated gas chromatography ion-trap mass spectrometry method. The ovarian reserve was assessed using ovarian reserve parameters: Hormones concentrations: E2 (estradiol), FSH (follicle stimulating hormone), AMH (anti-Müllerian hormone), and AFC (antral follicle count). Results: In the present study, the negative association between BPA urinary concentrations and AMH (p = 0.02) and AFC (p = 0.03) levels was found. Exposure to BPA was not related to other examined parameters of ovarian reserve (FSH, E2). Conclusions: Our results suggest that BPA exposure may affect women ovarian reserve parameters and reduce ovarian reserve. As this is one of the first studies of its kind, the findings need confirmation in a further investigation.

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Epinephrine minimizes the use of bipolar coagulation and preserves ovarian reserve in laparoscopic ovarian cystectomy: a randomized controlled trial

Scientific Reports ◽

10.1038/s41598-020-77781-w ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Eun Young Park ◽

Kyu-Hee Hwang ◽

Ji-Hee Kim ◽

San-Hui Lee ◽

Kyu-Sang Park ◽

...

Keyword(s):

Ovarian Reserve ◽

Ovarian Function ◽

Controlled Trial ◽

Antral Follicle ◽

Antral Follicle Count ◽

Histopathological Analysis ◽

Bipolar Coagulation ◽

Ovarian Cystectomy ◽

Novel Method ◽

Group Serum

AbstractWe propose a novel method, the epinephrine compression method (Epi-pledget), as a hemostasis method for ovarian cystectomy. A total of 179 patients undergoing laparoscopic ovarian cystectomy with stripping were randomly allocated into three groups: the bipolar coagulation group, the Epi-pledget group, and the coagulation after Epi-pledget (Epi & Coagulation) group. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) by ultrasonography were measured to determine the preservation of ovarian function. To evaluate the postoperative ovarian cellular proliferative activity and tissue damage in a mouse model, we operated on the ovaries of mice with an artificial incision injury and applied two hemostatic methods: coagulation and Epi-pledget. Eight weeks after surgery, the AMH rate significantly decreased in the bipolar coagulation group compared with the Epi-pledget group. The AFC decline rate was also significantly greater in the coagulation group than the Epi-pledget group. Specifically, patients with endometrioma had a significantly greater decline of serum AMH in the coagulation group than the Epi-pledget group. In a histopathological analysis in mice, the Epi-pledget group showed ameliorated fibrotic changes and necrotic findings in the injured lesion compared with the bipolar coagulation group. The Epi-pledget method for ovarian stripping has an additional benefit of maximizing the preservation of the ovarian reserve, especially for the endometriotic ovarian cyst type.

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