Predictors of ovarian reserve in young women with breast cancer

Abstract

Ovarian reserve can be diminished following treatment for breast cancer. This study evaluated biochemical and biophysical parameters of ovarian reserve in these patients. Biochemical and biophysical tests of ovarian reserve were performed simultaneously in young (age 22-42 years), regularly menstruating women with breast cancer (n=22) and age-matched controls (n=24). All tests were performed before (baseline) and after transient ovarian stimulation in the early follicular phase. Patients were recruited both before and after completion of chemotherapy, with some patients being followed up prospectively. Serum samples were analysed for follicle-stimulating hormone (FSH), luteinising hormone (LH), oestradiol (E(2)), inhibins A and B, and antimullerian hormone (AMH). Biophysical (ultrasound) tests included ovarian volume, antral follicle count (AFC), ovarian stromal blood flow and uterine dimensions. Significant differences were revealed (when compared with the controls) for basal FSH (11.32+/-1.48 vs 6.62+/-0.42 mIU ml(-1), P<0.001), basal AMH (0.95+/-0.34 vs 7.89+/-1.62 ng ml(-1), P<0.001) and basal inhibin B (19.24+/-4.56 vs 83.61+/-13.45 pg ml(-1), P<0.001). Following transient ovarian stimulation, there were significant differences in the increment change (Delta) for inhibin B (3.02+/-2.3 vs 96.82+/-16.38 pg ml(-1), P<0.001) and E(2) (107.8+/-23.95 vs 283.2+/-40.34 pg ml(-1), P<0.01). AFC was the only biophysical parameter that was significantly different between patients and the controls (7.80+/-0.85 vs 16.77+/-1.11, P<0.001). Basal and stimulated biochemical (serum AMH, FSH, inhibin B and E(2)) and biophysical (AFC) tests may be potential markers of ovarian reserve in young women with breast cancer.

Figure 1

(A) Clinical data of study group. This figure illustrates the mean age and BMI, respectively, of patients and controls in the cross-sectional analysis. BMI, body mass index; NS, no statistically significant difference. (B–D) Biochemical and biophysical parameters (cross-sectional data). Mean basal hormone parameters are displayed as well as delta (Δ) values, which are obtained by subtracting hormone levels obtained following stimulation from the baseline. (B) Follicle-stimulating hormone and E₂, (C) AMH and inhibin B, (D) total (and mean) AFC and OV. Significant differences are highlighted with an asterisk (^*) as follows: ^*P<0.05; ^**P<0.01; ^***P<0.001; NS, no statistically significant difference.

Figure 1

(A) Clinical data of study group. This figure illustrates the mean age and BMI, respectively, of patients and controls in the cross-sectional analysis. BMI, body mass index; NS, no statistically significant difference. (B–D) Biochemical and biophysical parameters (cross-sectional data). Mean basal hormone parameters are displayed as well as delta (Δ) values, which are obtained by subtracting hormone levels obtained following stimulation from the baseline. (B) Follicle-stimulating hormone and E₂, (C) AMH and inhibin B, (D) total (and mean) AFC and OV. Significant differences are highlighted with an asterisk (^*) as follows: ^*P<0.05; ^**P<0.01; ^***P<0.001; NS, no statistically significant difference.

Figure 2

Biochemical and biophysical parameters (longitudinal data). Mean basal levels of FSH, E₂, AMH, inhibin B, total AFC and total OV are displayed in the same patients tested in the early follicular phase pre-chemotherapy as well as immediately following completion of chemotherapy. Significant differences are highlighted with an asterisk (^*) as follows: ^*P< 0.05; ^**P<0.01; ^***P<0.001; NS, no statistically significant difference.