Breast Cancer Patients Recover Only Half of Their Pre Treatment Antral Follicle Count One Year after Exposure to Chemotherapy

Introduction: Premenopausal breast cancer patients treated with chemotherapy are at increased risk of reproductive compromise. Although the majority of patients will have return of menses within 1 year, they may suffer from early menopause and premature ovarian insufficiency.

Aim: To characterize the loss of ovarian reserve and the time to maximum ovarian recovery in women who regain their menstrual function after exposure to chemotherapy.

Material & Methods: A retrospective cohort study. We evaluated the medical records of all newly diagnosed cancer patients at the UCSF Center of Reproductive Health between 2009-2016 and identified 61 breast cancer patients who were seen prior to chemotherapy for a fertility preservation consult and after chemotherapy and return of menses for follow-up ovarian function assessments with antral follicle count (AFC) every 3-6 months. Follow-up AFC was compared to initial, pre-treatment AFC to create a ratio of the person`s follow-up AFC versus their original AFC. T-tests and general linear models (GLM) were used as appropriate to assess differences in AFC.

Results: The average age of the 61 women was 34 +/- 5 at their intake fertility preservation consult visit. Average intake (pre-chemotherapy) AFC was 17 +/- 12. The average number of AFC assessments was 2 +/- 1. 29 patients (48%) had ovarian suppression with GnRH agonist (Lupron, Abbott Laboratories) during chemotherapy and there was no significant difference in age or initial AFC between the GnRH agonist versus no GnRH agonist groups. AFC recovery appeared to plateau at 1 year after completing chemotherapy, to an average of 50% of original AFC. AFC recovered to 34% of the AFC expected for a patient’s given age. After adjustment for age and initial AFC, there was an increased AFC at 1 year post chemotherapy for those patients who used concomitant GnRH agonist ovarian protective treatment (p=0.047).

Conclusion: Women with resumed menses after chemotherapy for breast cancer recover only half of their pre-treatment ovarian reserve 1 year after their last chemotherapy dose. Concomitant treatment with GnRH agonist is associated with increased post-treatment ovarian reserve.