Ovarian Reserve in Women Who Remain Premenopausal After Chemotherapy for Early Stage Breast Cancer

Objective: To compare markers of ovarian reserve between women exposed to cytotoxic chemotherapy for early stage breast cancer and matched controls.

Design: Cross-sectional evaluation of markers of ovarian reserve.

Setting: Dana-Farber/Brigham and Women's Cancer Center, Massachusetts General Hospital, and Faulkner Hospital in Boston, MA.

Patient(s): Breast cancer survivors with continued menses after chemotherapy were compared with age-matched, gravidity-matched controls.

Main Outcome Measure(s): Antral follicle count (AFC), anti-Müllerian hormone (AMH), FSH, inhibin B (InB), and E(2) on day 2, 3, or 4 of the menstrual cycle. A Bonferroni correction was performed to correct for multiple comparisons.

Result(s): Twenty survivors and 20 controls were evaluated; 50% of survivors were currently on tamoxifen. Median AFC was 6 for survivors and 9.5 for controls. There were significant differences between the two groups in AFC, AMH, and nonsignificant differences in FSH and InB, all indicating better ovarian reserve in controls. The AFC and AMH levels were highly correlated (r = 0.72). Survivors on tamoxifen had lower AFC, AMH, InB, and higher E(2) than nontamoxifen-treated survivors.

Conclusion(s): Premenopausal breast cancer survivors have diminished ovarian reserve compared with controls.