Abstract
BackgroundPatients scheduled to receive chemotherapy should be counseled on fertility preservation. Known gonadotoxic chemotherapies such as alkylating agents have a high risk of altering ovarian reserve. In some cases, the urgency of treatment requires the use of chemotherapy before fertility preservation, which will be carried out at a later stage. Most often the ovarian tissue is cryopreserved. The aim of our study is to investigate the impact of chemotherapies on follicular density, tissue damage and apoptosis of reserve follicles.ResultsWe included 140 patients: 63 patients, mean age 18.8 years, were included in the group no chemotherapy (group A) and 77 patients, mean age 17.1 years, in the group presence of chemotherapy before ovarian conservation (group B). None of the patients had had pelvic radiotherapy prior to ovarian cryopreservation. The histological parameters studied were: follicular density, the presence of cortical fibrosis and the presence of vessel abnormalities. We selected 12 patients from group A and 15 patients from group B, comparable in age and pathology, for whom we evaluated follicle apoptosis by immunostaining cleaved caspase 3. We demonstrated an inverse relationship between follicular density and age (p<0.0001), as well as a lack of effect of chemotherapy on follicular density (p=0.87). There was no difference in other histological parameters. On the other hand, we showed an impact of chemotherapies, especially alkylating agents, on the apoptosis of ovarian follicles (p<0.0001).ConclusionOur study is the largest cohort reported to date. This work underlines that conservation of ovarian tissue after chemotherapy remains possible.