title: Reproductive function assessment after surgery plus chemotherapy for germ cell ovarian tumors (MOGCT): novel clues deriving from the field of fertility preservation.
abstract: Germ cell ovarian tumors (malignant ovarian germ cell tumors - MOGCT) affect young women and are treated by surgery plus chemotherapy. It is well known that cytotoxic treatment may accelerate depletion of the primordial follicle pool leading to impaired fertility and premature menopause. Aim of this study is to identify patient candidates for fertility preservation strategies. We report our experience in preservation of fertility for four patients affected by MOGCT, referred to San Raffaele Hospital Oncofertility Unit. All patients received fertility sparing surgery plus platinum-based chemotherapy. Two patients were affected by mixed germ cell tumors and two by disgerminomas. After 24 months from the end of treatment, serum AMH levels have been measured. We report lower serum anti-Mullerian hormone (AMH) levels in our patients than in healthy general population as serum AMH levels were under the 25th age-specific percentiles. Fertility preservation, in terms of oocytes cryopreservation, was offered to those two patients with serum AMH levels predictive of significantly poor ovarian reserve (1st and 2nd patients). Using the gonadotropin releasing hormone (GnRH) antagonist protocol for ovarian stimulation, we obtained two and six oocytes, respectively. Therefore, serum AMH, as a marker of ovarian function, can improve the identification of patients that need to be referred to fertility preservation strategies.
authors.affiliation: Department of Obstetrics and Gynecology, Oncofertility Unit, San Raffaele Scientific Institute , Milan , Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ottolina
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
authors.forename: Cristina
authors.initials: C
authors.lastname: Sigismondi
authors.forename: Valeria Stella
authors.initials: VS
authors.lastname: Vanni
authors.forename: Paola
authors.initials: P
authors.lastname: Viganò
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
mesh_terms: D000293:Adolescent; D054304:Anti-Mullerian Hormone / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols; D017024:Chemotherapy, Adjuvant; D005260:Female; D005298:Fertility / Q000502:physiology*; D059247:Fertility Preservation; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D010062:Ovulation Induction; D055815:Young Adult
chemical_list: D054304:Anti-Mullerian Hormone
keywords: Anti-Mullerian hormone; cytotoxic treatment; fertility preservation; germ cell ovarian tumors; infertility; oocytes cryopreservation; premature menopause