title: Anti-Müllerian hormone and antral follicle count reveal a late impairment of ovarian reserve in patients undergoing low-gonadotoxic regimens for hematological malignancies.
abstract: The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy received and time elapsed from the end of the therapy, we report that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importance of accurate counseling at the time of diagnosis of cancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors.
authors.affiliation: Department of Life and Reproduction Sciences, Section of Obstetrics and Gynecology and.
authors.forename: Rossana
authors.initials: R
authors.lastname: Di Paola
authors.forename: Claudio
authors.initials: C
authors.lastname: Costantini
authors.forename: Cristina
authors.initials: C
authors.lastname: Tecchio
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Salvagno
authors.forename: Rachele
authors.initials: R
authors.lastname: Montemezzi
authors.forename: Alessio
authors.initials: A
authors.lastname: Perandini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pizzolo
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaffagnini
authors.forename: Massimo
authors.initials: M
authors.lastname: Franchi
mesh_terms: D000293:Adolescent; D054304:Anti-Mullerian Hormone / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D059247:Fertility Preservation; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy; D006801:Humans; D028322:Inhibin-beta Subunits / Q000097:blood; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology / Q000528:radiation effects; D010053:Ovary / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology* / Q000528:radiation effects; D017741:Survivors; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D054304:Anti-Mullerian Hormone; D028322:Inhibin-beta Subunits
keywords: Anti-Müllerian hormone; Antral follicle count; Fertility preservation; Hematological malignancies