Impact of tamoxifen therapy on fertility in breast cancer survivors

• Type of Material: Article
• Authors: Lisa M. Shandley, Emory University; Jessica B Spencer, Emory University; Amy Fothergill, Emory University; Ann Mertens, Emory University; Amita Manatunga, Emory University; Elisavet Paplomata, Emory University; Penelope Howards, Emory University
• Language: English
• Date: 2017-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: ©2016 American Society for Reproductive Medicine, Published by Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.fertnstert.2016.10.020
• Title of Journal or Parent Work: Fertility and Sterility
• ISSN: 0015-0282
• Volume: 107
• Issue: 1
• Start Page: 243
• End Page: +
• Grant/Funding Information: Funding for this research was provided by The Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant 1R01HD066059 and supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers ULITR000454 and TL1TR000456.; The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: WOMEN; PREMENOPAUSAL; MARKERS; PREGNANCY; Reproductive Biology; cancer survivorship; OVARIAN RESERVE; Science & Technology; tamoxifen; infertility; Life Sciences & Biomedicine; CHEMOTHERAPY; ANTI-MULLERIAN HORMONE; RISK; Breast cancer; ovarian reserve; PRESERVATION; Obstetrics & Gynecology
• Research Categories: Health Sciences, Oncology; Health Sciences, Pharmacology

Abstract

Objective To determine whether tamoxifen use is associated with decreased ovarian reserve and decreased likelihood of having a child after a breast cancer diagnosis, using data from the Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women Study. Design Population-based cohort study. Setting Not applicable. Patient(s) Three hundred ninety-seven female breast cancer survivors aged 22–45 years whose cancer was diagnosed between ages 20 and 35 years and who were at least 2 years after diagnosis; 108 survivors also participated in a clinic visit. Intervention(s) None. Main Outcome Measure(s) Time to first child after cancer diagnosis, clinical measures of ovarian reserve (antimüllerian hormone [AMH] and antral follicle count [AFC] ) after cancer. Result(s) Women who had ever used tamoxifen were substantially less likely to have a child after the breast cancer diagnosis (hazard ratio [HR] 0.29; 95% confidence interval [CI] , 0.16, 0.54) than women who had never used tamoxifen. After adjusting for age at diagnosis, exposure to an alkylating agent, and race, the HR was 0.25 (95% CI, 0.14, 0.47). However, after adjusting for potential confounders, women who had used tamoxifen had an estimated geometric mean AMH level 2.47 times higher (95% CI, 1.08, 5.65) than women who had never taken tamoxifen. Antral follicle count was also higher in the tamoxifen group compared with the tamoxifen nonusers when adjusted for the same variables (risk ratio 1.21; 95% CI, 0.84, 1.73). Conclusion(s) Breast cancer survivors who had used tamoxifen were less likely to have a child after breast cancer diagnosis compared with survivors who never used tamoxifen. However, tamoxifen users did not have decreased ovarian reserve compared with the tamoxifen nonusers.