Impact of cancer treatment on risk of infertility and diminished ovarian reserve in women with polycystic ovary syndrome

BACKGROUND: To compare markers of fertility and ovarian reserve between cancer survivors and cancer-free women with and without PCOS. METHODS: FUCHSIA Women’s Study–a population-based cohort study. Female cancer survivors (n=۱,۴۵۲) aged ۲۵–۴۵ years, diagnosed between ages ۲۵–۳۵ years, and at least ۲ years post-diagnosis; ۳۱۸ participated in a clinic visit. Two hundred sixty-five reproductive-aged women without cancer also completed a clinic visit. Infertility, time to first pregnancy after cancer diagnosis, and measures of ovarian reserve (anti-Müllerian hormone [AMH] and antral follicle count [AFC]). RESULTS: Sixty-nine (۶.۹%) cancer survivors reported a PCOS diagnosis, with ۴۸ receiving gonadotoxic treatment. Survivors with PCOS exposed to gonadotoxic treatment (odds ratio [OR] ۲.۵, ۹۵% confidence interval [CI] ۱.۴, ۴.۵) and unexposed (OR ۳.۵, ۹۵% CI ۱.۸, ۶.۵) were more likely to report infertility than unexposed survivors without PCOS, and were more likely to have fewer children than desired (exposed: OR ۲.۱, ۹۵% CI ۱.۰, ۴.۲; unexposed: OR ۳.۲, ۹۵% CI ۱.۵, ۶.۶). After adjusting for age, comparison women with PCOS had the highest markers of ovarian reserve (AMH: ۲.۴۳ ng/mL, ۹۵% CI: ۱.۲۷, ۴.۸۲; AFC: ۲۰.۲, ۹۵% CI: ۱۵.۵, ۲۶۲) and cancer survivors without PCOS treated with gonadotoxic agents had the lowest levels (AMH: ۰.۲۲ ng/mL, ۹۵% CI: ۰.۱۴, ۰.۲۸; AFC: ۷.۴, ۹۵% CI: ۶.۷, ۸.۵). CONCLUSIONS: Despite having higher AMH and AFC on average after cancer treatment, cancer survivors with PCOS were less likely to meet their reproductive goals compared to survivors without PCOS.

کلیدواژه ها:

polycystic ovary syndrome ، cancer ، infertility ، ovarian reserve