title: Fertility and gonadal function after adjuvant therapy in women diagnosed with a malignant ovarian germ cell tumor (MOGCT) during the "cisplatin era".
abstract: OBJECTIVE
  By self-report and serum levels of anti-Mullerian hormone (AMH) this study aims to assess post-treatment fertility after modern treatment of women with malignant ovarian germ cell tumors (MOGCT).
  
  
  METHODS
  In 2013 a questionnaire-based survey was performed in 61 MOGCT patients diagnosed at age <40years from 1980-2009. Forty-nine of them also attended the out-patient clinic. The event of first post-treatment pregnancy ("fertility") was documented as cumulative estimates for all 61 patients and within each of 4 treatment groups: Group 1: Surgery only (n=10); Group 2: ≤3cycles of cisplatin-based chemotherapy (CBCT) (n=20); Group 3: >3cycles of CBCT (n=15) and Group 4: other adjuvant treatment (n=16). AMH was determined in 22 women <40years at survey. Statistics were based on Kaplan Meier procedure, log-rank test and a significance level p<0.05.
  
  
  RESULTS
  At least one post-treatment pregnancy was reported by 34 of 39 MOGCT survivors who attempted motherhood after treatment. The 15-year cumulative post-treatment fertility estimate was 28% (95% CI: 26-30) for all 61 survivors and was significantly higher in patients treated with 3 or fewer cycles of CBCT (53% [95% CI: 50-55]) than those treated with more than 3cycles (20% [95% CI: 17-22]) (P=0.03). Of 22 AMH levels, two were <3pmol/l, with one women being pregnant at survey.
  
  
  CONCLUSIONS
  After fertility-sparing surgery and modern cisplatin-based chemotherapy, fertility is preserved in most MOGCT survivors though dependent on the number of cycles. AMH's role as a biomarker of gonadal function seems promising but requires further research.
authors.affiliation: Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway. Electronic address: OLSOLH@ous-hf.no.
authors.forename: O
authors.initials: O
authors.lastname: Solheim
authors.affiliation: Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: C G
authors.initials: CG
authors.lastname: Tropé
authors.affiliation: Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
authors.forename: E
authors.initials: E
authors.lastname: Rokkones
authors.affiliation: Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Kærn
authors.affiliation: Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Paulsen
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
authors.forename: H B
authors.initials: HB
authors.lastname: Salvesen
authors.affiliation: Department of Gynaecology and Obstetrics, St. Olavs Hospital Trondheim, University Hospital, Trondheim, Norway.
authors.forename: B
authors.initials: B
authors.lastname: Hagen
authors.affiliation: Department of Clinical medicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: A B
authors.initials: AB
authors.lastname: Vereide
authors.affiliation: National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: S D
authors.initials: SD
authors.lastname: Fosså
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005298:Fertility / Q000187:drug effects*; D006066:Gonads / Q000187:drug effects*; D006801:Humans; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Cisplatin-based chemotherapy; Fertility; Ovarian germ cell cancer