Impact of breast cancer chemotherapy on ovarian reserve: a prospective observational analysis by menstrual history and ovarian reserve markers.
OBJECTIVE
To determine whether addition of taxanes to anthracycline and cyclophosphamide regimens impact ovarian function as assessed by menstrual history and ovarian reserve markers.


METHODS
Prospective observational analysis.


METHODS
Large university fertility center.


METHODS
Forty-five women with a history of breast cancer of stages I-IIIA who either received anthracycline, cyclophosphamide, and paclitaxel (ACT) or received anthracycline with cyclophosphamide (AC).


METHODS
Menstrual histories were obtained at 6 months and at a mean of 28 months after chemotherapy. Early follicular phase FSH and E(2) samples were obtained at the second follow-up.


METHODS
Incidence of amenorrhea and abnormal laboratory values.


RESULTS
There was no statistically significant difference in the rates of amenorrhea at 6 months after chemotherapy (AC group, 41.7%; ACT group, 29%). At the second follow-up, a mean of 28 months after chemotherapy, there was a trend toward higher amenorrhea in the ACT patients (35.7%, vs. 9.1% in the AC group). When the ovarian markers were included, an additional eight menstruating patients were identified with abnormally elevated FSH or E(2) levels.


CONCLUSIONS
We found no significant long- or short-term impact of taxanes on rates of amenorrhea. Future studies on the reproductive effects of chemotherapeutic agents should incorporate ovarian reserve markers, because menstrual history alone may underestimate the impact of these cytotoxic agents.
Reh
Andrea
A
Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York Presbyterian Weill Cornell Medical Center, New York, New York 10021, USA.
Oktem
Ozgur
O
Oktay
Kutluk
K
D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D008598:Menstruation / Q000187:drug effects*; D010053:Ovary / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors
D018943:Anthracyclines; D015415:Biomarkers; D004958:Estradiol; D003520:Cyclophosphamide; D005640:Follicle Stimulating Hormone; D017239:Paclitaxel