Ovarian reserve and response to IVF and in vitro maturation treatment following chemotherapy
Notice bibliographique
Résumé
BACKGROUND: Chemotherapy and radiotherapy can result in ovarian failure and premature menopause. However, there is still a paucity of information on the ovarian reserve and efficacy of assisted reproduction treatment (ART) procedures in patients with cancer previously exposed to chemotherapy or radiotherapy. The aim of our study was to evaluate the ovarian reserve and ovarian response to IVF or in vitro maturation (IVM) treatment in women who had previously been treated with chemotherapy. METHODS: In this retrospective cohort study, we compared 23 women with cancer who had undergone chemotherapy and subsequently underwent fertility treatment with IVF (n=14) or IVM (n=9). In the IVF group, patients mostly had hematologic, gynecologic, gastro-intestinal, bone and soft tissue cancers, whereas in the IVM group patients had estrogen-receptor positive breast cancer, hematologic and brain cancers. The control (unexposed) group consisted of 70 age-matched women with male factor infertility undergoing the same treatment protocol (IVF n=42 and IVM n=28). All women were aged<42 years and undergoing their first cycle of ART. RESULTS: There were no differences in age and FSH levels between the cancer and the control groups. However, the antral follicle count (AFC) was lower in the cancer-IVF group (median: 5, range: 3-12) than in the control group (median: 15, range: 12-18; P=0.0009). Women with cancer treated with IVF had lower peak estradiol levels on the day of hCG administration than controls (P=0.006) and lower number of oocytes retrieved [median: 4.5, range: 2-7; versus 12 (8-16) in controls; P<0.0001]. In patients with cancer treated with IVM, the AFC was lower than in the control group (median: 14, range: 9.5-17; versus median: 20.5 range: 16-23, respectively; P=0.0007). Likewise, the number of oocytes retrieved was lower in the cancer-IVM group (median: 6, range: 4-10) than that in the control group (median 10.5, range: 7.5-17; P=0.01). The percentage of mature metaphase II oocytes was comparable in the cancer and control groups. CONCLUSIONS: The ovarian reserve, response to gonadotrophins and number of oocytes retrieved are adversely affected by previous chemotherapy. This study reports the first series of IVM outcomes in cancer patients with a prior history of chemotherapy. In women with estrogen-receptor positive breast cancer, IVM of oocytes with cryopreservation of oocytes or embryos is a viable option. Since the efficacy of ART is significantly reduced after chemotherapy, early referral for fertility preservation before gonadotoxic treatment will give these young women the best chance to conceive.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».