Background: Primary Ovarian Insufficiency (POI) and infertility are common concerns of female Childhood Cancer Survivors (CCS) and are known to impact their quality of life. Increased availability of fertility preservation techniques mandate a better understanding of risk factors for POI in this population.
Objective and hypotheses: To describe the prevalence of and risk factors for POI in a cohort of adult CCS.
Method: Cross-sectional study of clinically assessed participants in an established cohort. POI was defined by delayed or interrupted puberty or persistent amenorrhea 5 years after the completion of cancer treatments (acute ovarian failure (AOF)) or menopause at age <40 years (premature menopause (PM)). Patients with hypogonadotropic hypogonadism, bilateral oophorectomy, Turner syndrome and those whose ovarian function could not be evaluated were excluded. Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and POI. Exposure to alkylating agents (AA) was quantified using the validated cyclophosphamide equivalent dose (CED).
Results: 921 patients (median age 31.7 years, range 19.060.6) were evaluated at a median of 24.0 years (range 10.248.1) after cancer diagnosis; 153 were treated with pelvic radiotherapy (PRT) and 546 with AA. 100 patients had POI (prevalence 10.9%); 58 had AOF and 42 PM. Factors independently associated with POI were: age >25 years at study (OR 7.2; 95%CI 3.017.6), exposure to any PRT (dose <10 Gy (OR 26.8; 95%CI 12.657.0); dose ≥10 Gy (OR 208.6; 95%CI 88.6491.0)) and CED 800011999 mg/m2 (OR 4.7; 95%CI 1.316.9) or ≥12 000 mg/m2 (OR 9.5; 95%CI 3.030.2).
Conclusion: POI is frequently seen in female CCS. The risk of POI increases with age and AA dose; PRT at any dose is associated with the highest risk. Patients should be counselled regarding their risk of POI; those at highest risk should be offered fertility preservation whenever feasible.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology