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Abstract
Introduction/Background Currently, all professional bodies endorse fertility preservation counseling and care in reproductive age group women planning to undergo treatment with gonadotoxic drugs.
Methodology A prospective cohort study was done. Ultrasound was done between days 2 -5 of the menstrual cycle to note antral follicle count and ovarian volume at the start of chemotherapy, at the completion of the first and second cycles of chemotherapy, as the biophysical surrogates of ovarian reserve. Likewise, blood samples drawn for FSH and LH levels were centrifuged, plasma was stored at -80 degrees Celsius, and analysis was performed in batches. Women were followed up 3 months following the completion of chemotherapy.
Results A total of 55 women with the mean age of the cohort was 38.98 years and the median parity was 3. Mean AFC, ovarian volume, FSH, and LH were noted at three predefined points and were compared. There was a statistically significant reduction in mean AFC (from 11.83 to 8.37, F=37.28 ; P < 0.001), serum FSH (from 23.01 to 61.44 ; P < 0.001), and serum LH (from 13.05 to 22.38 ; P < 0.001) values and ovarian volume when baseline values were compared to levels following 2 cycles of chemotherapy. The binary logistic model showed that the preservation of the menstrual function of a woman subsequent to chemotherapy was significantly impacted by female age at the start of chemotherapy (> 40 years, OR 0.015, P=0.005).
Conclusion Chemotherapy adversely affected the ovarian reserve of women in the reproductive age group. Female age at the initiation of chemotherapy was an important modulating parameter for the gonadotoxic effect of the chemotherapy. There was a higher trend for loss of menstrual function with alkylating agents, anthracyclines, and platinum-based agents. However, large sample studies are required to prove the finding.
Disclosures No conflict of interest.
