Ovarian function in female survivors of childhood malignancies

摘要

Background: Chemotherapy-induced infertility is a common side effect observed in women of fertile age after treatment for malignant disease. Objectives: to study gonadal function and fertility in female survivors of childhood malignancies. Patients and methods: Study included 30 female cancer survivors and 30 age-matched healthy females as a control group. Data collected regarding; type of malignancy, age at diagnosis, duration on and off treatment, treatment received (radiation or chemotherapeutic regimens), sexual, menstrual, pregnancy, and fertility histories were also recorded. Laboratory investigations included; T4, thyroid stimulating hormone (TSH), leutinizing hormone (LH), follicular stimulating hormone (FSH), and anti-Mullerian hormone (AMH). Pelviabdominal ultrasound was done to estimate the mean ovarian volume. Results: Among patients; 80% had normal menarche and 6 (20%) had delayed menarche (P .05). There was higher LH and FSH levels and lower AMH levels in patients (P .05) with no significant difference in thyroid function tests (P .05). Lower mean ovarian volume was observed among female survivors (6.32 ± 2.31 cm3) (P = .041). There was a higher FSH and LH levels among female survivors of solid tumors compared to those with hematological tumors (P = .05 and .04 respectively). There was a significant positive correlation between FSH level and patients' age at start of malignancy (r = 0.65, P = .014), age of menarche (r = 0.74, P = .036), and duration of treatment (r = 0.54, P = .025).There was a significant negative correlation between age of menarche and AMH level (r = -0.61, P = .03). Conclusion: Female survivors of childhood malignancies had reduced ovarian reserve and reduced mean ovarian volume, especially those with older age, older age of menarche, and longer treatment duration.