Anti-Müllerian hormone and fertility in women after childhood cancer treatment : Association with current infertility risk classifications
(2024) In PLoS ONE 19(8). p.1-18- Abstract
Background To identify childhood cancer survivors (CCSs) at risk of premature ovarian insufficiency (POI) and impaired fertility is important given its impact on quality of life. The aim of this study was to assess ovarian markers and fertility outcomes in adult female CCSs. We used the Swedish and the PanCareLIFE classifications for infertility risk grouping. Methods 167 CCSs, at median age 34.6 years (19.3–57.8) with a median follow-up time of 25.4 years (11.6–41.3), and 164 healthy matched controls were included in this cross-sectional study. We assessed anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), ovarian volume (OV), and fertility outcomes. Based on gonadotoxic treatments given, CCSs were categorized into... (More)
Background To identify childhood cancer survivors (CCSs) at risk of premature ovarian insufficiency (POI) and impaired fertility is important given its impact on quality of life. The aim of this study was to assess ovarian markers and fertility outcomes in adult female CCSs. We used the Swedish and the PanCareLIFE classifications for infertility risk grouping. Methods 167 CCSs, at median age 34.6 years (19.3–57.8) with a median follow-up time of 25.4 years (11.6–41.3), and 164 healthy matched controls were included in this cross-sectional study. We assessed anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), ovarian volume (OV), and fertility outcomes. Based on gonadotoxic treatments given, CCSs were categorized into infertility risk groups. Results The median levels of AMH, AFC and OV were lower in CCSs (1.9 vs. 2.1 ng/ml, 12.0 vs. 13.0, 6.8 vs. 8.0 cm3) compared with controls, although statistically significant only for OV (p = 0.021). AMH levels in CCSs <40 years were lower for those classified as high-risk (p = 0.034) and very high-risk (p<0.001) for infertility, based on the Swedish risk classification. Similarly, AFC was reduced in the high-risk (p<0.001) and the very high-risk groups (p = 0.003). CCSs of all ages showed a trend towards impaired fertility, especially in the very high-risk group. POI was diagnosed in 22/167 CCSs, of whom 14 were in the high- and very high-risk groups. The results according to the PanCareLIFE classification were similar. Conclusion Both the Swedish and the PanCareLIFE infertility risk classifications are reliable tools for identifying those at risk of reduced ovarian markers and fertility, as well as POI. We recommend fertility preservation counselling for patients receiving highly gonadotoxic treatments (i.e., Cyclophosphamide Equivalent Dose ≥6 g/m2, radiotherapy exposure to ovaries or stem cell transplantation) with follow-up at a young reproductive age due to the risk of a shortened reproductive window.
(Less)
- author
- Nyström, Anna LU ; Mörse, Helena LU ; Øra, Ingrid LU ; Henic, Emir LU ; Engellau, Jacob LU ; Wieslander, Elinore LU ; Tomaszewicz, Andrzej and Elfving, Maria LU
- organization
- publishing date
- 2024-08
- type
- Contribution to journal
- publication status
- published
- subject
- in
- PLoS ONE
- volume
- 19
- issue
- 8
- article number
- e0308827
- pages
- 1 - 18
- publisher
- Public Library of Science (PLoS)
- external identifiers
-
- scopus:85201116264
- pmid:39133666
- ISSN
- 1932-6203
- DOI
- 10.1371/journal.pone.0308827
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2024 Nyström et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
- id
- f93b81c0-bb7e-43f7-8036-7c0f93e4de46
- date added to LUP
- 2024-08-30 05:42:57
- date last changed
- 2024-08-31 03:00:20
@article{f93b81c0-bb7e-43f7-8036-7c0f93e4de46, abstract = {{<p>Background To identify childhood cancer survivors (CCSs) at risk of premature ovarian insufficiency (POI) and impaired fertility is important given its impact on quality of life. The aim of this study was to assess ovarian markers and fertility outcomes in adult female CCSs. We used the Swedish and the PanCareLIFE classifications for infertility risk grouping. Methods 167 CCSs, at median age 34.6 years (19.3–57.8) with a median follow-up time of 25.4 years (11.6–41.3), and 164 healthy matched controls were included in this cross-sectional study. We assessed anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), ovarian volume (OV), and fertility outcomes. Based on gonadotoxic treatments given, CCSs were categorized into infertility risk groups. Results The median levels of AMH, AFC and OV were lower in CCSs (1.9 vs. 2.1 ng/ml, 12.0 vs. 13.0, 6.8 vs. 8.0 cm<sup>3</sup>) compared with controls, although statistically significant only for OV (p = 0.021). AMH levels in CCSs <40 years were lower for those classified as high-risk (p = 0.034) and very high-risk (p<0.001) for infertility, based on the Swedish risk classification. Similarly, AFC was reduced in the high-risk (p<0.001) and the very high-risk groups (p = 0.003). CCSs of all ages showed a trend towards impaired fertility, especially in the very high-risk group. POI was diagnosed in 22/167 CCSs, of whom 14 were in the high- and very high-risk groups. The results according to the PanCareLIFE classification were similar. Conclusion Both the Swedish and the PanCareLIFE infertility risk classifications are reliable tools for identifying those at risk of reduced ovarian markers and fertility, as well as POI. We recommend fertility preservation counselling for patients receiving highly gonadotoxic treatments (i.e., Cyclophosphamide Equivalent Dose ≥6 g/m<sup>2</sup>, radiotherapy exposure to ovaries or stem cell transplantation) with follow-up at a young reproductive age due to the risk of a shortened reproductive window.</p>}}, author = {{Nyström, Anna and Mörse, Helena and Øra, Ingrid and Henic, Emir and Engellau, Jacob and Wieslander, Elinore and Tomaszewicz, Andrzej and Elfving, Maria}}, issn = {{1932-6203}}, language = {{eng}}, number = {{8}}, pages = {{1--18}}, publisher = {{Public Library of Science (PLoS)}}, series = {{PLoS ONE}}, title = {{Anti-Müllerian hormone and fertility in women after childhood cancer treatment : Association with current infertility risk classifications}}, url = {{http://dx.doi.org/10.1371/journal.pone.0308827}}, doi = {{10.1371/journal.pone.0308827}}, volume = {{19}}, year = {{2024}}, }