Introduction: Composed anticancer treatment leads to different late effects, such as ovarian failure, causing infertility or premature menopause.
Aim of the study: was to analyse ovarian function, particularly anti-mullerian hormone levels, in young females after anticancer treatment.
Patients and methods: We analysed FSH, LH, estradiol and anti-mullerian hormone (AMH) levels on days 3-5 of a menstrual cycle in thirty three cancer survivors in mean age 19.1+/-4.7 years treated in age 12.0+/-5.6 years for Hodgkin Lymphoma (HL) (n=16), nephroblastoma (n=7), soft tissue sarcoma (n=4), germinal tumor (n=3), neuroblastoma (n=2), histiocytosis (n=1). Infradiaphragmatic radiotherapy was needed in 16 patients (10 treated for HL). Results were compared with healthy girls of the same age.
Results: The mean values of FSH, LH, E2 and AMH did not differ in all survivors comparing to controls. Patients treated for HL with chemo- and radiotherapy presented higher FSH levels than controls (8.53+/-3.25 vs. 5.8+/-2.03 mIU/ml; p=0.045). Mean AMH levels were lower in all patients that received radiotherapy for the infradiaphragmatic region (17.19+/-14.84 pmol/l) than in controls (29.40+/-13.2 pmol/l; p=0.037). Particular analysis of all cases showed higher (>2 SD) FSH levels in 8 patients: 5 patients treated for HL with radiotherapy and higher total doses of procarbazine, nitrogen mustard and vinblastine; 2 patients treated for soft tissue sarcoma and one patient for Wilms tumor (all received radiotherapy). Lowered AMH levels were found in 8 patients treated with chemo- and radiotherapy (4 - for HL, 2 - for Wilms tumor and 2 - for soft tissue sarcoma).
Conclusion: Composed anticancer treatment, especially radiotherapy, leads to ovarian failure. Decreased AMH values at young adulthood suggest a lower ovarian reserve. All causes and first symptoms of ovary damage should be known to the doctors who take care of the patients after anticancer treatment.