Female cancer survivors exposed to alkylating-agent chemotherapy have unique reproductive hormone profiles.
OBJECTIVE
To evaluate reproductive hormone patterns in women exposed to alkylating-agent chemotherapy.


METHODS
Prospective cohort.


METHODS
University hospital.


METHODS
Normally menstruating mid-reproductive-age women (20-35 years old) who had previously been exposed to alkylating-agent chemotherapy for cancer treatment were compared with two healthy control populations: similarly-aged women and late-reproductive-age women (43-50 years old).


METHODS
Subjects collected daily urine samples for one cycle.


METHODS
Integrated urinary pregnanediol glucuronide (PDG) and estrone conjugate (E1c) and urinary excretion of gonadotropins (FSH and LH).


RESULTS
Thirty-eight women (13 survivors, 11 same-age control subjects, 14 late-reproductive-age control subjects) provided 1,082 urine samples. Cycle length, luteal phase length, and evidence of luteal activity were similar among the groups. As expected, ovarian reserve was impaired in cancer survivors compared with same-age control subjects but similar between survivors and late-reproductive-age control subjects. In contrast, survivors had total and peak PDG levels that were similar to same-age control subjects and higher than those observed in late-reproductive-age control subjects. Survivors had higher E1c levels than both same-age and late-reproductive-age control subjects. There was no difference in urinary gonadotropins among the groups.


CONCLUSIONS
Women exposed to alkylating agents have a unique reproductive hormone milieu that is not solely explained by age or ovarian reserve. The urinary hormone profile observed in survivors appears more similar to same-age control subjects than to late-reproductive-age women with similar ovarian reserve, which may suggest that age plays a more important role than ovarian reserve in the follicular dynamics of survivors.
Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Reproductive Endocrinology Associates of Charlotte, Charlotte, North Carolina. Electronic address: laurenjohnsonmd@gmail.com.
Lauren
L
Johnson
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
Mary D
MD
Sammel
Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Allison
A
Schanne
Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Lara
L
Lechtenberg
Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Maureen
M
Prewitt
Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Clarisa
C
Gracia
D000328:Adult; D000367:Age Factors; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D004970:Estrone / Q000031:analogs & derivatives / Q000652:urine*; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000652:urine*; D020719:Glucuronides / Q000652:urine*; D006785:Hospitals, University; D006801:Humans; D007986:Luteinizing Hormone / Q000652:urine*; D008875:Middle Aged; D065851:Ovarian Reserve / Q000187:drug effects; D010060:Ovulation / Q000187:drug effects*; D011276:Pregnanediol / Q000031:analogs & derivatives / Q000652:urine*; D011446:Prospective Studies; D016482:Urinalysis; D055815:Young Adult
D018906:Antineoplastic Agents, Alkylating; D015415:Biomarkers; D043373:Follicle Stimulating Hormone, Human; D020719:Glucuronides; D004970:Estrone; D007986:Luteinizing Hormone; D011276:Pregnanediol
E1c; PDG; Progesterone excretion; cancer survivors; urinary hormones
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