title: Outcomes of ovarian stimulation after treatment with chemotherapy.
abstract: OBJECTIVE
  Chemotherapeutic agents have a known gonadotoxic effect; however, it is difficult to predict the impact they may have on ovarian stimulation. The objective of this study was to evaluate response to ovarian stimulation in patients exposed to chemotherapy compared with patients who were chemotherapy-naïve.
  
  
  METHODS
  A retrospective cohort study of 130 patients with cancer or autoimmune disease was performed. Demographics, ovarian reserve, ovarian response and stimulation parameters, and oocyte data were compared between patients who were pre- and post-chemotherapy. Logistic regression modeling was performed to identify risk factors for cancellation and low oocyte yield, adjusting for confounders as appropriate.
  
  
  RESULTS
  Antral follicle count (AFC) was significantly lower in post-chemo patients (9 vs. 17, p < 0.001). Post-chemotherapy patients were more likely to be cancelled during stimulation (23 vs. 4 %, p = 0.003). Among those that went to retrieval, there was no difference in total number of oocytes (10 vs. 10, p = 0.31) or mature oocytes retrieved (8 vs. 8, p = 0.38), despite higher starting (300 vs. 450 IU, p < 0.001) and total gonadotropin (3075 vs. 4612.5 IU, p = 0.008) doses in post-chemotherapy patients. Low AFC (≤6) was associated with cycle cancellation (OR 7.7, 95 % CI 1.8-33.2) and low oocyte yield (<6) (OR 5.4, 95 % CI 1.6-17.7).
  
  
  CONCLUSIONS
  Patients post-chemotherapy have lower AFC compared with the chemotherapy-naïve and have higher cancellation rates. Among those who underwent oocyte retrieval, oocyte yield was similar in both groups. Low AFC was most strongly associated with cycle cancellation and oocyte yield. Post-chemotherapy patients had higher rates of cycle cancellation but did equally well as pre-chemotherapy patients if they reached retrieval.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA. jessica.chan@uphs.upenn.edu.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Chan
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
authors.forename: Lauren N C
authors.initials: LN
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Efymow
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, 605 Blockley Hall, Philadelphia, PA, 19104, USA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
authors.forename: Clarisa R
authors.initials: CR
authors.lastname: Gracia
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D009369:Neoplasms / Q000188:drug therapy*; D054315:Oocyte Retrieval / Q000379:methods*; D009865:Oocytes / Q000187:drug effects; D006080:Ovarian Follicle / Q000187:drug effects; D065851:Ovarian Reserve / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006062:Gonadotropins
keywords: Cancer; Chemotherapy; Fertility preservation; Ovarian stimulation