Dynamics and mechanisms of chemotherapy-induced ovarian follicular depletion in women of fertile age.
OBJECTIVE
To study ovarian follicular dynamics during chemotherapy to understand the mechanisms behind chemotherapy-induced ovarian follicular depletion and to evaluate whether pretreatment levels of ovarian reserve markers were predictive of the posttreatment levels.


METHODS
Prospective clinical study.


METHODS
University hospital fertility center.


METHODS
Seventeen women (median age 30 years; range 19-35 years) undergoing chemotherapy.


METHODS
Patients were seen before, frequently during, and after chemotherapy, until 1 year after the end of treatment. Antral follicle count and levels of FSH, LH, E(2), anti-Müllerian hormone (AMH), and inhibin A and B were monitored at each visit.


METHODS
The dynamics of the ovarian reserve markers during chemotherapy and factors predictive of posttreatment ovarian function.


RESULTS
Anti-Müllerian hormone level (mean +/- 2 SEM) dropped from 2.7 +/- 1.0 to 1.1 +/- 0.6 and to 0.4 +/- 0.4 ng/mL immediately after one and two series of chemotherapy, respectively. Inhibin B and antral follicle count decreased after three series whereas FSH reached menopausal levels after four series. High pretreatment AMH levels predicted higher posttreatment AMH levels.


CONCLUSIONS
Anti-Müllerian hormone and inhibin B levels immediately declined in response to chemotherapy, and the follicular target of chemotherapy appeared to be growing follicles. High pretreatment AMH levels were predictive of a higher posttreatment AMH level.
Rosendahl
Mikkel
M
The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. mikkel.rosendahl@rh.regionh.dk
Andersen
Claus Yding
CY
la Cour Freiesleben
Nina
N
Juul
Anders
A
Løssl
Kristine
K
Andersen
Anders Nyboe
AN