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Katzir T, Shrem G, Meirow D, Berkowitz E, Elizur S, Cohen S, Burke Y, Retchkiman M, Or Y, Volodarsky-Perel A. Fertility preservation parameters in patients with haematologic malignancy: a systematic review and meta-analysis. Reprod Biomed Online 2024; 49:103978. [PMID: 38805862 DOI: 10.1016/j.rbmo.2024.103978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 05/30/2024]
Abstract
Patients with haematologic malignancies represent one of the most common groups referred for fertility preservation before gonadotoxic oncological treatment. The aim of this systematic review and meta-analysis was to evaluate the effect of haematologic cancer on ovarian reserve and response to ovarian stimulation compared with healthy controls. A total of eight observative studies were included in the final quantitative analysis. Despite a younger age (mean difference -4.17, 95% CI -6.20 to -2.14; P < 0.0001), patients with haematologic malignancy had lower serum anti-Müllerian hormone levels compared with the control group (MD -1.04, 95% CI -1.80 to -0.29; P = 0.007). The marginally higher total recombinant FSH dose (MD 632.32, 95% CI -187.60 to 1452.24; P = 0.13) and significantly lower peak oestradiol serum level (MD -994.05, 95% CI -1962.09 to -26.02; P = 0.04) were demonstrated in the study group compared with the healthy controls. A similar number of retrieved oocytes were achieved in both groups (MD 0.20, 95% CI -0.80 to 1.20; P = 0.69). In conclusion, haematologic malignancies may detrimentally affect ovarian function manifesting in decreased AMH serum levels despite a younger age compared with healthy controls. This effect can be overcome by the application of relevant IVF protocols and stimulation doses to achieve an adequate oocyte yield.
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Affiliation(s)
- Tamar Katzir
- Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Guy Shrem
- Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dror Meirow
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Berkowitz
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Elizur
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yechiel Burke
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Retchkiman
- Soroka Medical Center, Be'er Sheva, Israel; The Faculty of Medicine, Ben Gurion University, Be'er Sheva, Israel
| | - Yuval Or
- Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Alexander Volodarsky-Perel
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel..
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2
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Maidarti M, Tarumi W, Takae S, Wiweko B, Suzuki N. Paclitaxel is evidence to reduce growing ovarian follicle growth in mice model study. Toxicol In Vitro 2022; 83:105386. [DOI: 10.1016/j.tiv.2022.105386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/24/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023]
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3
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Caponnetto A, Battaglia R, Ragusa M, Barbagallo D, Lunelio F, Borzì P, Scollo P, Purrello M, Vento ME, Di Pietro C. Molecular profiling of follicular fluid microRNAs in young women affected by Hodgkin lymphoma. Reprod Biomed Online 2021; 43:1045-1056. [PMID: 34627683 DOI: 10.1016/j.rbmo.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
RESEARCH QUESTION Treatments for Hodgkin lymphoma have improved but one of their common effects is gonadal toxicity, which contributes to fertility damage of patients and induces temporary or irreversible loss of fertility. Could micro-RNA (miRNA) expression profiles in follicular fluid be influenced by Hodgkin lymphoma? Could their alteration affect molecular pathways involved in follicle growth and oocyte maturation? DESIGN miRNA expression profile was investigated in follicular fluid samples from young women affected by Hodgkin lymphoma compared with healthy controls by NanoString technology. Bioinformatic analysis was used to verify miRNA involvement in follicle development and miRNA deregulation with Hodgkin lymphoma in a larger cohort of follicular fluid samples was confirmed by real-time quantitative polymerase chain reaction. RESULTS Thirteen miRNAs are deregulated in Hodgkin lymphoma samples compared with controls and are involved in molecular pathways related to cancer, gametogenesis and embryogenesis. Among them, let-7b-5p, miR-423-5p, miR-503-5p, miR-574-5p and miR-1303 are implicated in biological processes related to follicle development and oocyte maturation. Let-7b-5p holds the central position in the regulatory network of miRNA-mRNA interactions, has the highest number of mRNA target genes shared with the other differentially expressed miRNAs and is significantly downregulated in Hodgkin lymphoma follicular fluid samples. CONCLUSIONS These data led us to question the potential influence of miRNA deregulation on oocyte quality. Further studies are needed to verify the reproductive potential of young patients with Hodgkin lymphoma before starting chemotherapy protocols and an adequate protocol of fertility preservation needs to be guaranteed.
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Affiliation(s)
- Angela Caponnetto
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics 'Giovanni Sichel', University of Catania, Catania 95123, Italy
| | - Rosalia Battaglia
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics 'Giovanni Sichel', University of Catania, Catania 95123, Italy.
| | - Marco Ragusa
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics 'Giovanni Sichel', University of Catania, Catania 95123, Italy; Oasi Research Institute-IRCCS, Troina 94018, Italy
| | - Davide Barbagallo
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics 'Giovanni Sichel', University of Catania, Catania 95123, Italy; Interdisciplinary Research Centre on the Diagnosis and Therapy of Brain Tumors, University of Catania, Catania 95123, Italy
| | | | | | | | - Michele Purrello
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics 'Giovanni Sichel', University of Catania, Catania 95123, Italy
| | | | - Cinzia Di Pietro
- Department of Biomedical and Biotechnological Sciences, Section of Biology and Genetics 'Giovanni Sichel', University of Catania, Catania 95123, Italy
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Segers I, Bardhi E, Mateizel I, Van Moer E, Schots R, Verheyen G, Tournaye H, De Vos M. Live births following fertility preservation using in-vitro maturation of ovarian tissue oocytes. Hum Reprod 2021; 35:2026-2036. [PMID: 32829388 DOI: 10.1093/humrep/deaa175] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Can oocytes extracted from excised ovarian tissue and matured in vitro be a useful adjunct for urgent fertility preservation (FP)? SUMMARY ANSWER Ovarian tissue oocyte in-vitro maturation (OTO-IVM) in combination with ovarian tissue cryopreservation (OTC) is a valuable adjunct technique for FP. WHAT IS KNOWN ALREADY Despite the impressive progress in the field, options for FP for cancer patients are still limited and, depending on the technique, clinical outcome data are still scarce. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study conducted at a university hospital-affiliated fertility clinic between January 2012 and May 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS The study included 77 patients who underwent unilateral oophorectomy for OTC. Cumulus-oocyte complexes (COCs) obtained during ovarian tissue processing were matured in vitro for 28-42 h. Oocytes reaching metaphase II stage were vitrified or inseminated for embryo vitrification. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 1220 COCs were collected. The mean oocyte maturation rate was 39% ± 23% (SD). There were 64 patients who had vitrification of oocytes (6.7 ± 6.3 oocytes per patient). There were 13 patients who had ICSI of mature oocytes after IVM, with 2.0 ± 2.0 embryos vitrified per patient. Twelve patients have returned to the clinic with a desire for pregnancy. For seven of these, OTO-IVM material was thawed. Two patients had OTO-IVM oocytes warmed, with survival rates of 86% and 60%. After ICSI, six oocytes were fertilised in total, generating three good quality embryos for transfer, leading to a healthy live birth for one patient. In five patients, for whom a mean of 2.0 ± 0.8 (SD) embryos had been vitrified, seven embryos were warmed in total: one embryo did not survive the warming process; two tested genetically unsuitable for transfer; and four were transferred in separate cycles to three different patients, resulting in two healthy babies. In this small series, the live birth rate per patient after OTO-IVM, ICSI and embryo transfer was 43%. LIMITATIONS, REASONS FOR CAUTION The retrospective study design and the limited sample size should be considered when interpreting results. WIDER IMPLICATIONS OF THE FINDINGS The results of the study illustrate the added value of OTO-IVM in combination with OTC. We report the first live birth following the use of this appended technique combined with oocyte vitrification. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. M.D.V. reports honoraria for lectures in the last 2 years from MSD and Ferring, outside the submitted work, as well as grant support from MSD. The other authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ingrid Segers
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Erlisa Bardhi
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium.,Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Roma, Italy
| | - Ileana Mateizel
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Ellen Van Moer
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Rik Schots
- Department of Hematology, University Hospital Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Greta Verheyen
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Herman Tournaye
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Michel De Vos
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium.,Follicle Biology Laboratory (FOBI), UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels 1090, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
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5
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Qu J, Li Y, Liao S, Yan J. The Effects of Negative Elements in Environment and Cancer on Female Reproductive System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1300:283-313. [PMID: 33523439 DOI: 10.1007/978-981-33-4187-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
With the development of human society, factors that contribute to the impairment of female fertility is accumulating. Lifestyle-related risk factors, occupational risk factors, and iatrogenic factors, including cancer and anti-cancer treatments, have been recognized with their negative effects on the function of female reproductive system. However, the exact influences and their possible mechanism have not been elucidated yet. It is impossible to accurately estimate the indexes of female fertility, but many researchers have put forward that the general fertility has inclined through the past decades. Thus the demand for fertility preservation has increased more and more dramatically. Here we described some of the factors which may influence female reproductive system and methods for fertility preservation in response to female infertility.
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Affiliation(s)
- Jiangxue Qu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yuehan Li
- Department of Gynaecology and Obstetrics, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shujie Liao
- Department of Gynaecology and Obstetrics, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jie Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
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6
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Liu D, Yan J, Qiao J. Effects of malignancies on fertility preservation outcomes and relevant cryobiological advances. SCIENCE CHINA-LIFE SCIENCES 2019; 63:217-227. [DOI: 10.1007/s11427-019-9526-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/03/2019] [Indexed: 01/04/2023]
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7
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Harzif AK, Wiweko B, Addina P, Iswaranti K, Silvia M, Mariana A, Mutia K, Sumapraja K, Muharam R, Pratama G. Anti-Mullerian hormone levels in female cancer patients of reproductive age in Indonesia: A cross-sectional study. F1000Res 2019; 8:159. [PMID: 32185016 PMCID: PMC7059784 DOI: 10.12688/f1000research.15728.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 03/29/2024] Open
Abstract
Background: Efforts in reproductive preservation for cancer patients have become one of the important aspects of cancer management. In fact, decline in reproductive function is known to occur after exposure to anti-cancer treatments. Measuring anti-Müllerian hormone (AMH) levels is known to be the best parameter in predicting ovarian reserves, which indicates reproductive function. In total, 68% of cancer survivors of reproductive age who underwent anti-cancer treatments suffer from infertility. Meanwhile, ovarian reserves also decrease with increasing age. There is ongoing debate on whether the ovarian reserves of cancer patients could be reduced long before exposure to anti-cancer therapy. Therefore, it is important to know whether ovarian reserves in cancer patients decrease before or after anti-cancer therapy. This can help predict the reproductive function in such cases and the effectiveness of ovarian preservation efforts. Methods: A cross-sectional study was conducted, comparing the AMH levels of 44 female cancer patients of reproductive age before cancer therapy, to 44 non-cancer patients of reproductive age (age matched) . The biological ages from both groups were adjusted using the Indonesian Kalkulator of Oocytes. Results: The median age in both groups was 28 years old. The AMH levels in the cancer group were found to be significantly lower in contrast to those in the non-cancer group (1.11 [0.08-4.65] ng/ml vs. 3.99 [1.19- 8.7]; p- value <0.001). Therefore, the biological age in the cancer group was 10 years older than that of the non-cancer group, indicating that ovarian aging occurs earlier in cancer patients. Conclusions: AMH levels of cancer patients of reproductive age were already reduced before cancer therapy, given an older biological age, in contrast to that of the non-cancer patients. Proper counseling and implementation of fertility-preserving methods is highly recommended in this group of patients.
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Affiliation(s)
- Achmad Kemal Harzif
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Budi Wiweko
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Putri Addina
- Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kartika Iswaranti
- Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Melisa Silvia
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Ana Mariana
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kresna Mutia
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kanadi Sumapraja
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - R Muharam
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Gita Pratama
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
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8
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Harzif AK, Wiweko B, Addina P, Iswaranti K, Silvia M, Mariana A, Mutia K, Sumapraja K, Muharam R, Pratama G. Anti-Mullerian hormone levels in female cancer patients of reproductive age in Indonesia: A cross-sectional study. F1000Res 2019; 8:159. [PMID: 32185016 PMCID: PMC7059784 DOI: 10.12688/f1000research.15728.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 03/29/2024] Open
Abstract
Background: Efforts in reproductive preservation for cancer patients have become one of the important aspects of cancer management. In fact, decline in reproductive function is known to occur after exposure to anti-cancer treatments. Measuring anti-Müllerian hormone (AMH) levels is known to be the best parameter in predicting ovarian reserves, which indicates reproductive function. In total, 68% of cancer survivors of reproductive age who underwent anti-cancer treatments suffer from infertility. Meanwhile, ovarian reserves also decrease with increasing age. There is ongoing debate on whether the ovarian reserves of cancer patients could be reduced long before exposure to anti-cancer therapy. Therefore, it is important to know whether ovarian reserves in cancer patients decrease before or after anti-cancer therapy. This can help predict the reproductive function in such cases and the effectiveness of ovarian preservation efforts. Methods: A cross-sectional study was conducted, comparing the AMH levels of 44 female cancer patients of reproductive age before cancer therapy, to 44 non-cancer patients of reproductive age (age matched) . The biological ages from both groups were adjusted using the Indonesian Kalkulator of Oocytes. Results: The median age in both groups was 28 years old. The AMH levels in the cancer group were found to be significantly lower in contrast to those in the non-cancer group (1.11 [0.08-4.65] ng/ml vs. 3.99 [1.19- 8.7]; p- value <0.001). Therefore, the biological age in the cancer group was 10 years older than that of the non-cancer group, indicating that ovarian aging occurs earlier in cancer patients. Conclusions: AMH levels of cancer patients of reproductive age were already reduced before cancer therapy, given an older biological age, in contrast to that of the non-cancer patients. Proper counseling and implementation of fertility-preserving methods is highly recommended in this group of patients.
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Affiliation(s)
- Achmad Kemal Harzif
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Budi Wiweko
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Putri Addina
- Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kartika Iswaranti
- Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Melisa Silvia
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Ana Mariana
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kresna Mutia
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kanadi Sumapraja
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - R Muharam
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Gita Pratama
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
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9
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Harzif AK, Wiweko B, Addina P, Iswaranti K, Silvia M, Mariana A, Mutia K, Sumapraja K, Muharam R, Pratama G. Anti-Mullerian hormone levels in female cancer patients of reproductive age in Indonesia: A cross-sectional study. F1000Res 2019; 8:159. [PMID: 32185016 PMCID: PMC7059784 DOI: 10.12688/f1000research.15728.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Efforts in reproductive preservation for cancer patients have become one of the important aspects of cancer management. In fact, decline in reproductive function is known to occur after exposure to anti-cancer treatments. Measuring anti-Müllerian hormone (AMH) levels is known to be the best parameter in predicting ovarian reserves, which indicates reproductive function. In total, 68% of cancer survivors of reproductive age who underwent anti-cancer treatments suffer from infertility. Meanwhile, ovarian reserves also decrease with increasing age. There is ongoing debate on whether the ovarian reserves of cancer patients could be reduced long before exposure to anti-cancer therapy. Therefore, it is important to know whether ovarian reserves in cancer patients decrease before or after anti-cancer therapy. This can help predict the reproductive function in such cases and the effectiveness of ovarian preservation efforts. Methods: A cross-sectional study was conducted, comparing the AMH levels of 44 female cancer patients of reproductive age before cancer therapy, to 44 non-cancer patients of reproductive age (age matched) . The AMH was determined from blood.The biological ages from both groups were adjusted using the Indonesian Kalkulator of Oocytes. Results: The median age in both groups was 28 years old. The AMH levels in the blood of the cancer group were found to be significantly lower in contrast to those in the non-cancer group (1.11 [0.08-4.65] ng/ml vs. 3.99 [1.19- 8.7]; p- value <0.001). Therefore, the biological age in the cancer group was 10 years older than that of the non-cancer group, indicating that ovarian aging occurs earlier in cancer patients. Conclusions: AMH levels of cancer patients of reproductive age were already reduced before cancer therapy, given an older biological age, in contrast to that of the non-cancer patients. Proper counseling and implementation of fertility-preserving methods is highly recommended in this group of patients.
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Affiliation(s)
- Achmad Kemal Harzif
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Budi Wiweko
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Putri Addina
- Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kartika Iswaranti
- Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Melisa Silvia
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Ana Mariana
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kresna Mutia
- Indonesian Reproductive Medicine Research and Training Center (INA-REPROMED) of Faculty of Medicine Universitas Indonesia,, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Kanadi Sumapraja
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - R Muharam
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
| | - Gita Pratama
- Division of Reproductive Endocrionolgy and Infertility, Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta Province, Indonesia
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10
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Traila A, Dima D, Achimas-Cadariu P, Micu R. Fertility preservation in Hodgkin's lymphoma patients that undergo targeted molecular therapies: an important step forward from the chemotherapy era. Cancer Manag Res 2018; 10:1517-1526. [PMID: 29942153 PMCID: PMC6005299 DOI: 10.2147/cmar.s154819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In total, 80%-90% of Hodgkin's lymphoma (HL) patients are curable with combination chemoradiotherapy. Due to improvements in therapeutic strategies, 50% of all relapsed/refractory patients may undergo complete clinical responses and have long-term survival. Treatment options for HL are effective, but may have a negative impact on post-chemotherapy fertility. Thus, cryopreservation of semen prior to treatment is recommended for male patients. For female patients, assisted reproductive techniques (ART) consult and fertility preservation should be offered as a therapeutical option. In the last years, new targeted molecules have been available for HL treatment. These new drugs showed a high rate of overall responses in the setting of heavily pretreated patients, most of them in relapse after autologous stem cell transplantation, a group previously considered very poor risk. Up to 50% of patients have a complete response and an improved overall survival. Future studies will address the usefulness of novel molecules as a frontline therapy. Considering the high response and survival rates with monoclonal antibody-based therapeutics, fertility has become a concerning issue for long-term HL survivors. As progress has been made regarding ART, with the rigorous steps planned for HL patients, more survivors will become parents.
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Affiliation(s)
- Alexandra Traila
- School of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
- Department of Surgical Oncology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Patriciu Achimas-Cadariu
- School of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
- Department of Surgical Oncology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Romeo Micu
- School of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
- Department of Human Assisted Reproduction of 1st Gynecology Clinic, Cluj Napoca, Romania
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Gupta AA, Lee Chong A, Deveault C, Traubici J, Maloney AM, Knight S, Lorenzo A, Allen L. Anti-Müllerian Hormone in Female Adolescent Cancer Patients Before, During, and After Completion of Therapy: A Pilot Feasibility Study. J Pediatr Adolesc Gynecol 2016; 29:599-603. [PMID: 27184535 DOI: 10.1016/j.jpag.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Alkylating agents are implicated in premature ovarian insufficiency. To optimize counseling regarding future ovarian function in survivors of adolescent cancer, we describe anti-Müllerian hormone (AMH) levels in female adolescents at diagnosis, during, and shortly after completion of chemotherapy. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a prospective single-institution study. Participants were a mixed population of newly diagnosed postmenarchal female adolescents with malignancy. AMH was performed at diagnosis (T1), 6 months from diagnosis (T2), at end of therapy or 12 months [T3, whichever came first], 1 year after the end of therapy or 24 months from diagnosis [T4, whichever came first], and 18 months from the time of diagnosis (T5). All patients had baseline pelvic ultrasound examinations. Presence of menses and hot flashes were recorded at each time point. RESULTS Sixteen participants with a median age at diagnosis of 14.3 years (range 12-17 years) were followed for 18.2 months (range, 14-24 months). Oncology diagnoses included leukemia, lymphoma, and sarcoma. Ten patients (62.5%) received alkylating agents with a median cumulative dose of 3041 mg/m2 (range, 2639-6478 mg/m2) of cyclophosphamide. Almost half (n = 7; 44%) experienced amenorrhea during treatment with resumption of menses in 6 of 7 patients (85%). Fifteen of 16 (94%) participants showed a decline in mean AMH levels by 6 months (T2) from diagnosis (15.8 IU/mL at T1 vs 6.5 IU/mL at T2; P = .003) and 12 of 15 (80%) showed at least some recovery of AMH (mean AMH at T4 = 13.2 IU/mL compared with 6.5 IU/mL at T2; P = .02). There was no difference in the mean decline nor recovery of AMH in those who did, vs did not receive cyclophosphamide. CONCLUSION To our knowledge, this is the largest series to date in adolescents showing that AMH is uniformly suppressed during cancer therapy and short-term recovery occurs in just more than half of the patients by 18-24 months. The contribution of short-term AMH measurements in predicting long-term ovarian function remains to be defined. Long-term follow-up with serial AMH levels is required to help predict those at risk for premature ovarian insufficiency.
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Affiliation(s)
- Abha A Gupta
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Amy Lee Chong
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Deveault
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Traubici
- Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne Marie Maloney
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Knight
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Armando Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Allen
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Paradisi R, Vicenti R, Macciocca M, Seracchioli R, Rossi S, Fabbri R. High cytokine expression and reduced ovarian reserve in patients with Hodgkin lymphoma or non-Hodgkin lymphoma. Fertil Steril 2016; 106:1176-1182. [PMID: 27430206 DOI: 10.1016/j.fertnstert.2016.06.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/23/2016] [Accepted: 06/20/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the ovarian reserve in female lymphoma patients and the potential relationships with the cytokine network. DESIGN Age-matched control study. SETTING Women's university hospital. PATIENT(S) Seventy-three lymphoma patients (57 with classic Hodgkin lymphoma [HL] and 16 with non-Hodgkin lymphoma [NHL]), approaching our center for ovarian tissue cryopreservation (study group) were compared with 25 age-matched healthy volunteers (control group). INTERVENTION(S) Measurements of antimüllerian hormone (AMH), soluble interleukin-2 receptor (SIL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor α (TNF-α) levels. MAIN OUTCOME MEASURE(S) The AMH and cytokine levels of the lymphoma patients and the healthy volunteers were compared. Correlations between AMH with SIL-2R, IL-6, and IL-8 levels were performed. RESULT(S) The AMH showed significant lower concentrations in lymphoma patients than in the control group. Higher significant concentrations in lymphoma patients than in control group were found for SIL-2R and IL-6. No differences were observed comparing HL and NHL groups and within the stages of HL group for AMH and all the cytokines analyzed. Finally, significant inverse correlations were observed in lymphoma patients between AMH and SIL-2R, IL-6, and IL-8 levels, but not with TNF-α levels. Positive correlations between SIL-2R with IL-6, and IL-6 with IL-8 were also shown. CONCLUSION(S) In patients with HL or NHL at baseline the cytokine network is particularly active and the ovarian reserve is reduced. A strong negative correlation between AMH and SIL-2R, IL-6, and IL-8 has been also evidenced.
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Affiliation(s)
- Roberto Paradisi
- Gynecology and Physiopathology of Human Reproductive Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Rossella Vicenti
- Gynecology and Physiopathology of Human Reproductive Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Macciocca
- Gynecology and Physiopathology of Human Reproductive Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Renato Seracchioli
- Gynecology and Physiopathology of Human Reproductive Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefania Rossi
- Gynecology and Physiopathology of Human Reproductive Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Raffaella Fabbri
- Gynecology and Physiopathology of Human Reproductive Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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13
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Barr RD. Risk of Premature Menopause After Treatment for Hodgkin's Lymphoma. J Natl Cancer Inst 2014; 106:dju231. [DOI: 10.1093/jnci/dju231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Confocal laser scanning microscopy analysis of bioenergetic potential and oxidative stress in fresh and frozen-thawed human ovarian tissue from oncologic patients. Fertil Steril 2014; 101:795-804. [DOI: 10.1016/j.fertnstert.2013.11.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/19/2013] [Accepted: 11/22/2013] [Indexed: 11/20/2022]
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15
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van Dorp W, van den Heuvel-Eibrink MM, de Vries ACH, Pluijm SMF, Visser JA, Pieters R, Laven JSE. Decreased serum anti-Mullerian hormone levels in girls with newly diagnosed cancer. Hum Reprod 2013; 29:337-42. [DOI: 10.1093/humrep/det442] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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16
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Fabbri R, Pasquinelli G, Parazza I, Macciocca M, Magnani V, Battaglia C, Paradisi R, Venturoli S. Effects of Cyclic Increase in Gonadotropins on theIn VitroDevelopment of Primordial Follicles to Antral Stage. Ultrastruct Pathol 2012; 36:356-61. [DOI: 10.3109/01913123.2012.679353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Cryopreservation of ovarian tissue in pediatric patients. Obstet Gynecol Int 2012; 2012:910698. [PMID: 22518166 PMCID: PMC3306942 DOI: 10.1155/2012/910698] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/22/2011] [Indexed: 11/28/2022] Open
Abstract
Cancer treatments improve the survival rate of children and adolescents; however chemo- and radiotherapy result in gonadal damage leading to acute ovarian failure and sterility. Ovarian tissue cryopreservation allows long-term storage of primordial follicles and represents the only possibility of preserving the potential fertility in prepubertal girls. The aim of the present study is to describe our experience in ovarian tissue cryopreservation in 45 pediatric patients. The number of follicles per square millimeter of the overall section area and follicle quality were evaluated histologically. A strong negative correlation was found between age and follicular density in patients both prior to and after chemotherapy (P < 0.0001). Damage in follicular quality, that is, increased oocyte vacuolization and detachment of the oocyte from granulosa cells, was found after chemotherapy. Ovarian tissue cryopreservation, preferably performed before initiation of chemotherapy, should be offered to pediatric patients, including prepubertal girls, at risk of sterility.
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