Dynamics and mechanisms of chemotherapy-induced ovarian follicular depletion in women of fertile age

Objective: To study ovarian follicular dynamics during chemotherapy to understand the mechanisms behind chemotherapy-induced ovarian follicular depletion and to evaluate whether pretreatment levels of ovarian reserve markers were predictive of the posttreatment levels. Design: Prospective clinical study. Setting: University hospital fertility center. Patient(s): Seventeen women (median age 30 years; range 19-35 years) undergoing chemotherapy. Intervention(s): Patients were seen before, frequently during, and after chemotherapy, until 1 year after the end of treatment. Antral follicle count and levels of FSH, LH, E-2, anti-Mullerian hormone (AMH), and inhibin A and B were monitored at each visit. Main Outcome Measure(s): The dynamics of the ovarian reserve markers during chemotherapy and factors predictive of posttreatment ovarian function. Result(s): Anti-Mullerian hormone level (mean +/- 2 SEM) dropped from 2.7 +/- 1.0 to 1.1 +/- 0.6 and to 0.4 +/- 0.4 ng/mL immediately after one and two series of chemotherapy, respectively. Inhibin B and antral follicle count decreased after three series whereas FSH reached menopausal levels after four series. High pretreatment AMH levels predicted higher posttreatment AMH levels. Conclusion(s): Anti-Mullerian hormone and inhibin B levels immediately declined in response to chemotherapy, and the follicular target of chemotherapy appeared to be growing follicles. High pretreatment AMH levels were predictive of a higher posttreatment AMH level. (Fertil Steril (R) 2010; 94: 156-66. (C) 2010 by American Society for Reproductive Medicine.)