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

• Type of Material: Article
• Authors: Lisa M. Shandley, Emory University; Amy Fothergill, Emory University; Jessica Spencer, Emory University; Ann Mertens, Emory University; Hanh N. Cottrell, Emory University; Penelope Howards, Emory University
• Language: English
• Date: 2018-03-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Society for Reproductive Medicine
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.fertnstert.2017.11.016
• Title of Journal or Parent Work: Fertility and Sterility
• ISSN: 0015-0282
• Volume: 109
• Issue: 3
• Start Page: 516
• 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.
• Keywords: CHEMOTHERAPY; BREAST-CANCER; ovarian reserve; HISTORY; DIAGNOSTIC-CRITERIA; POPULATION; ANTI-MULLERIAN HORMONE; MARKERS; Reproductive Biology; SYNDROME PCOS; Cancer; Obstetrics & Gynecology; infertility; Science & Technology; Life Sciences & Biomedicine; polycystic ovary syndrome; HEALTH; AMH
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Oncology

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.