ANTI-MÜLLERIAN HORMONE AND ANTRAL FOLLICLE COUNT REVEAL A LATE IMPAIR- MENT OF OVARIAN RESERVE IN PATIENTS UNDERGONE LOW GONADOTOXIC REGIMENS FOR HAEMATOLOGICAL MALIGNANCIES

The impact of cancer therapy on the reproductive potential of patients is increasingly being recognized as survival rates of patients have clear- ly improved over the recent years. Different fertility preservation meth- ods, either generally accepted or still experimental, are currently avail- able, and counseling of patients requires a delicate balance between effi- cacy and side-effects of the proposed method and the characteristics of both the tumor and the therapy. A deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. Here, we report a case-control study in which 63 female patients diag- nosed with haematological malignancies (44 Hodgkin Lymphoma; 13 non-Hodgkin Lymphoma; 6 Acute Myeloid Leukemia) and treated with chemo- and/or radiotherapy were compared to 64 age-matched controls in terms of ovarian reserve, as measured by ultrasound examination (antral follicle count) and hormonal status (follicle-stimulating hormone (FSH), anti-müllerian hormone (AMH), Inhibin-B). By stratifying patients for gonadotoxicity of the therapy received and time elapsed from the end of the therapy, we report that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within few years from the end of the therapy, show a clear impairment over longer times. We also report that AMH is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared to FSH or Inhibin-B. This study stresses the importance of accurate counseling at the time of diagnoses of cancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors.