title: Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer.
abstract: BACKGROUND
  The authors sought to describe the age-specific impact of infertility and early menopause after chemotherapy among reproductive age women with cancer.
  
  
  METHODS
  A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on reproductive health history. Five cancer types were included: leukemia, Hodgkin disease (HD), non-Hodgkin lymphoma (NHL), breast cancer, and gastrointestinal(GI) cancer. Survey questions addressed acute ovarian failure (cessation of menses after treatment), early menopause (menopause before 45 years old), and infertility (failed conception). Logistic regression was used to determine the proportions of acute ovarian failure and infertility based on age at diagnosis. Censored data methods were used to determine the probability of early menopause.
  
  
  RESULTS
  Six hundred twenty women received chemotherapy alone. The percentage reporting acute ovarian failure was 8%, 10%, 9%, and 5% for HD, NHL, breast cancer, and GI cancer, respectively. Acute ovarian failure increased significantly with age at diagnosis (P < .05). In subjects not reporting acute ovarian failure, the incidence of infertility was at least 40% at age 35 years and increased significantly with age at diagnosis in HD and breast cancer (P < .05). The estimated probability of early menopause was at least 25% at age 30 years and increased significantly with younger age at diagnosis in HD, NHL, and GI cancer (P < .05).
  
  
  CONCLUSIONS
  For patients to receive appropriate counseling, it is important that they understand the potential increased risk of infertility and early menopause beyond that of acute ovarian failure. These findings can provide improved, age-specific counseling regarding reproductive impairment for young women diagnosed with cancer.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Letourneau
authors.forename: Erin E
authors.initials: EE
authors.lastname: Ebbel
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.forename: Kutluk H
authors.initials: KH
authors.lastname: Oktay
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.forename: Wei Z
authors.initials: WZ
authors.lastname: Ai
authors.forename: A Jo
authors.initials: AJ
authors.lastname: Chien
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Melisko
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.forename: Mitchell P
authors.initials: MP
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced*; D008594:Menopause, Premature / Q000187:drug effects*; D009369:Neoplasms / Q000188:drug therapy; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced*; D012306:Risk