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Comparison serum levels of anti-mullerian hormone in cancer patients, who underwent cryopreservation of whole ovary vs. partial ovary
ovulation. Nevertheless, stimulation was continued with 375 iu rec-FSH x 2 days, HCG 10K was given and retrieval was performed 36 hours later.
best of our knowledge this is the first study that compared between patients with partial and whole ovary cryopreservation. Supported by: None.
TABLE 1. End of Stimulation
Days FSH 8 9 10 11
Meds Let 5mg/FSH 225/ ganarelix 250 Let 5/FSH 375/ ganarelix 250 Let 5/FSH 375/ ganarelix 250 Let 5/10k HCG
E2
LH
P4
Lgst Follicles
170
15
3
16,12,11,11
62
2
5
14,13,12,11
68
2
10
16,14,13,12
90
1.6
20
20,18,16,16,15
RESULTS: Six oocytes were obtained and 4 fertilized after ICSI. Four embryos were cryopreserved at the 2 PN stage. The patient was given 11.25 mg leuprolide acetate one week after retrieval and began chemotherapy. CONCLUSIONS: We hypothesized that since granulosa cells within the follicles less than 10-12 mm in size would not have sufficient LH receptors to have been affected by this patient’s endogenous LH surge (1) the smaller follicles might be ‘‘salvageable’’ if FSH support were continued. Since cryopreservation was planned, endometrial dysynchrony was not a concern. There have been isolated reports of superfetation resulting from ovulation induction performed inadvertantly during early pregnancy (2), but to our knowledge, this is the first report of successful oocyte retrieval/embryo cryopreservation deliberately performed in the luteal phase. Due to the desire to begin treatment as soon as possible, expedient cycle initiation is a priority when oocytes/embryos are being cryopreserved for future use in cancer patients. It is not always feasible to await the next menses. This case demonstrates that it is possible to recruit follicles and complete folliculogenesis despite a spontaneous LH surge Therefore, it may be possible to initiate stimulation in any phase of the cycle when time is of the essence. 1 -Filcori M Fertil Steri Aug 2005; 84(2) 2- Lefebvre G Fertil Steril 1990 June; 53(6). Supported by: None.
A-229 COMPARISON SERUM LEVELS OF ANTI-MULLERIAN HORMONE IN CANCER PATIENTS, WHO UNDERWENT CRYOPRESERVATION OF WHOLE OVARY VS. PARTIAL OVARY. F. Azem, A. Massarwa, D. Kovelsky, I. Wagman, T. Shwartz, A. Amit. Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel. OBJECTIVE: To compare ovarian reserve by measuring serum AntiMulleria Hormone (AMH) lecels amonfg cancer patients. DESIGN: Retrospective study. MATERIALS AND METHODS: The study included 49 cancer patients. From whom in 21 we got complete data regarding: menstrual status, day 3 (basal): FSH, E2, AMH and antral follicle count (AFC), and 3 patients with AMH levels only. 12 patients underwent partial ovarian cryopreservation (Group A) and 12 patients underwent cryopreservation of the whole ovary (Group B). The two groups were comparable in the average age, indications for cryopreservation and mode of chemo/radiotherapy. In both groups ovaries were exposed to chemotherapeutic agents which affected similarly the ovarian reserve. RESULTS: The two groups were comparable in regard to average age, indications for chemotherapy, levels of basal FSH, AMH and AFC. However we found that positive correlation between FSH; and AFC (p ¼ 0.001, r ¼ - 0. 662) and between AMH and AFC (p ¼ 0.019, r ¼ 0.506). The percentage of patients with reduced ovarian reserve was comparable between the two groups 5 in each group with good ovarian reserve, same thing happened regarding to poor ovarian reserve assessed in 7 patients each group. The two groups were slightly different regarding ovarian reserve when assested by FSH and AFC but the difference wasn’t statisticly significant (p ¼ 0.67). CONCLUSIONS: Ovarian reserve as assessed by the measurement of AMH, basal FSH and antral follicles count, showed no statistical difference between the study groups. In patients in whom the ovarian reserve could severely be affected following chemotherapy; one should consider application of whole ovary cryopreservation rather than partial cryopreservation. To the
S450
Abstracts
A-231 THE IMPACT OF CHEMOTHERAPY ON OVARIAN FUNCTION IN PREMENOPAUSAL PATIENTS WITH BREAST CANCER. D. Yang, M. Ding, Y. Mo, Q. Zhang, W. Wang, Y. Li. Sun Yat-sen University, Guangzhou, China. OBJECTIVE: 1. To study the impact of chemotherapy of breast cancer on ovarian function of premenopausal patients and the associate factors. 2. To evaluate the effect of AMH as a markers of ovarian reserve in patients with breast cancer. DESIGN: It’s case-control retrospective study of premenopausal breast cancer survivors who ever experienced chemotherapy. MATERIALS AND METHODS: Menstruation situation after chemotherapy were record in 120 female cancer survivors.Anti-Mullerian hormone(AMH) and follicle-stimulating hormone(FSH) were measured in 30 of these patients. 30 healthy volunteers with regular menses and comparable ages were studied as controls. All data were analyzed by SPSS 15.0. A P value of <0.05 was considered statistically significant. RESULTS: Incidence of amenorrhea rises along with patient age, the rates are 22.2%, 40.0% and 73.8%, respectively. The mean age of the amenorrhea group is higher than the irregular menstruation group and the regular menstruation group. At the reporting time points of 12 months, 24 months and 36 months after the start of chemotherapy, the rates of amenorrhea are 50.5%, 49.2% and 55.6% respectively. The standard regimens of CEF, CMF and ET are associated with amenorrhea rates of 57.5%, 18.2% and 54.8%.The serum concentration of FSH in the 30 survivors are significantly higher than the 30 controls, while the AMH levels are much lower. Moreover, the amenorrhea group has higher FSH concentrations than the irregular menstruation group while AMH has no statistical difference. In the regular menstruation group, FSH levels are significant higher. The survivors with FSH <20 IU/l have significantly lower AMH. FSH has negative correlation with AMH in patient group. CONCLUSIONS: The commonly used adjuvant chemotherapy regimens for breast cancer may lead to ovarian damage,which is associated with the patient age. The older, the easier amenorrhea would happen. Survivors with regular menstrual cycles seemed to have a diminished ovarian reserve. The serum AMH has negative correlation with FSH, it could be used to describe ovarian reserve of patient after chemotherapy. Supported by: 1. Science Technology Research Project of Guangdong Province (Grant No. 2007B080701014) 2. The Specialized Research Fund for the Doctoral Program of Ministry of Education of China(Grant No. 20050558093) 3. ‘‘Sun Yat-Sen University Clinical Research 5010 Program(Grant No. 2007–017) 4. National Natural Science Foundation of China(Grant No. 30700860) 5. National Natural Science Foundation of China(Grant No. 30700899.
A-232 MOHS MICROGRAPHIC SURGERY FOR FERTILITY PRESERVATION IN A 46 XX TRUE HERMAPHRODITE. J. E. Taylor, H. Browne, G. S. Rose, A. H. DeCherney. Program in Reproductive and Adult Endocrinology, NICHD, National Institutes of Health, Bethesda, MD; Department of Gynecologic Oncology, Walter Reed Army Medical Center, Washington, DC. OBJECTIVE: To present a novel surgical approach for fertility preservation in a true hermaphrodite who is status-post a unilateral salpingo-oophorectomy for an ovotestis with a gonadoblastoma. DESIGN: Case report. MATERIALS AND METHODS: 20-year-old nulliparous African-American female who was found to have a left ovotestis with a gonadoblastoma and intratubular germ cell neoplasia on pathology after undergoing an exploratory laparotomy and left salpingo-oophorectomy prior to admission for a persistent 9 cm complex left adnexal mass. A CT scan of her abdomen and pelvis did not reveal any evidence of metastatic disease and ovarian tumor markers were negative. Of note, she has had clitoromegaly since she was an infant, and moderate facial acne that developed after puberty. Endocrine studies were significant for an elevated serum total testosterone
Vol. 90, Suppl 1, September 2008
best of our knowledge this is the first study that compared between patients with partial and whole ovary cryopreservation. Supported by: None.
TABLE 1. End of Stimulation
Days FSH 8 9 10 11
Meds Let 5mg/FSH 225/ ganarelix 250 Let 5/FSH 375/ ganarelix 250 Let 5/FSH 375/ ganarelix 250 Let 5/10k HCG
E2
LH
P4
Lgst Follicles
170
15
3
16,12,11,11
62
2
5
14,13,12,11
68
2
10
16,14,13,12
90
1.6
20
20,18,16,16,15
RESULTS: Six oocytes were obtained and 4 fertilized after ICSI. Four embryos were cryopreserved at the 2 PN stage. The patient was given 11.25 mg leuprolide acetate one week after retrieval and began chemotherapy. CONCLUSIONS: We hypothesized that since granulosa cells within the follicles less than 10-12 mm in size would not have sufficient LH receptors to have been affected by this patient’s endogenous LH surge (1) the smaller follicles might be ‘‘salvageable’’ if FSH support were continued. Since cryopreservation was planned, endometrial dysynchrony was not a concern. There have been isolated reports of superfetation resulting from ovulation induction performed inadvertantly during early pregnancy (2), but to our knowledge, this is the first report of successful oocyte retrieval/embryo cryopreservation deliberately performed in the luteal phase. Due to the desire to begin treatment as soon as possible, expedient cycle initiation is a priority when oocytes/embryos are being cryopreserved for future use in cancer patients. It is not always feasible to await the next menses. This case demonstrates that it is possible to recruit follicles and complete folliculogenesis despite a spontaneous LH surge Therefore, it may be possible to initiate stimulation in any phase of the cycle when time is of the essence. 1 -Filcori M Fertil Steri Aug 2005; 84(2) 2- Lefebvre G Fertil Steril 1990 June; 53(6). Supported by: None.
A-229 COMPARISON SERUM LEVELS OF ANTI-MULLERIAN HORMONE IN CANCER PATIENTS, WHO UNDERWENT CRYOPRESERVATION OF WHOLE OVARY VS. PARTIAL OVARY. F. Azem, A. Massarwa, D. Kovelsky, I. Wagman, T. Shwartz, A. Amit. Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel. OBJECTIVE: To compare ovarian reserve by measuring serum AntiMulleria Hormone (AMH) lecels amonfg cancer patients. DESIGN: Retrospective study. MATERIALS AND METHODS: The study included 49 cancer patients. From whom in 21 we got complete data regarding: menstrual status, day 3 (basal): FSH, E2, AMH and antral follicle count (AFC), and 3 patients with AMH levels only. 12 patients underwent partial ovarian cryopreservation (Group A) and 12 patients underwent cryopreservation of the whole ovary (Group B). The two groups were comparable in the average age, indications for cryopreservation and mode of chemo/radiotherapy. In both groups ovaries were exposed to chemotherapeutic agents which affected similarly the ovarian reserve. RESULTS: The two groups were comparable in regard to average age, indications for chemotherapy, levels of basal FSH, AMH and AFC. However we found that positive correlation between FSH; and AFC (p ¼ 0.001, r ¼ - 0. 662) and between AMH and AFC (p ¼ 0.019, r ¼ 0.506). The percentage of patients with reduced ovarian reserve was comparable between the two groups 5 in each group with good ovarian reserve, same thing happened regarding to poor ovarian reserve assessed in 7 patients each group. The two groups were slightly different regarding ovarian reserve when assested by FSH and AFC but the difference wasn’t statisticly significant (p ¼ 0.67). CONCLUSIONS: Ovarian reserve as assessed by the measurement of AMH, basal FSH and antral follicles count, showed no statistical difference between the study groups. In patients in whom the ovarian reserve could severely be affected following chemotherapy; one should consider application of whole ovary cryopreservation rather than partial cryopreservation. To the
S450
Abstracts
A-231 THE IMPACT OF CHEMOTHERAPY ON OVARIAN FUNCTION IN PREMENOPAUSAL PATIENTS WITH BREAST CANCER. D. Yang, M. Ding, Y. Mo, Q. Zhang, W. Wang, Y. Li. Sun Yat-sen University, Guangzhou, China. OBJECTIVE: 1. To study the impact of chemotherapy of breast cancer on ovarian function of premenopausal patients and the associate factors. 2. To evaluate the effect of AMH as a markers of ovarian reserve in patients with breast cancer. DESIGN: It’s case-control retrospective study of premenopausal breast cancer survivors who ever experienced chemotherapy. MATERIALS AND METHODS: Menstruation situation after chemotherapy were record in 120 female cancer survivors.Anti-Mullerian hormone(AMH) and follicle-stimulating hormone(FSH) were measured in 30 of these patients. 30 healthy volunteers with regular menses and comparable ages were studied as controls. All data were analyzed by SPSS 15.0. A P value of <0.05 was considered statistically significant. RESULTS: Incidence of amenorrhea rises along with patient age, the rates are 22.2%, 40.0% and 73.8%, respectively. The mean age of the amenorrhea group is higher than the irregular menstruation group and the regular menstruation group. At the reporting time points of 12 months, 24 months and 36 months after the start of chemotherapy, the rates of amenorrhea are 50.5%, 49.2% and 55.6% respectively. The standard regimens of CEF, CMF and ET are associated with amenorrhea rates of 57.5%, 18.2% and 54.8%.The serum concentration of FSH in the 30 survivors are significantly higher than the 30 controls, while the AMH levels are much lower. Moreover, the amenorrhea group has higher FSH concentrations than the irregular menstruation group while AMH has no statistical difference. In the regular menstruation group, FSH levels are significant higher. The survivors with FSH <20 IU/l have significantly lower AMH. FSH has negative correlation with AMH in patient group. CONCLUSIONS: The commonly used adjuvant chemotherapy regimens for breast cancer may lead to ovarian damage,which is associated with the patient age. The older, the easier amenorrhea would happen. Survivors with regular menstrual cycles seemed to have a diminished ovarian reserve. The serum AMH has negative correlation with FSH, it could be used to describe ovarian reserve of patient after chemotherapy. Supported by: 1. Science Technology Research Project of Guangdong Province (Grant No. 2007B080701014) 2. The Specialized Research Fund for the Doctoral Program of Ministry of Education of China(Grant No. 20050558093) 3. ‘‘Sun Yat-Sen University Clinical Research 5010 Program(Grant No. 2007–017) 4. National Natural Science Foundation of China(Grant No. 30700860) 5. National Natural Science Foundation of China(Grant No. 30700899.
A-232 MOHS MICROGRAPHIC SURGERY FOR FERTILITY PRESERVATION IN A 46 XX TRUE HERMAPHRODITE. J. E. Taylor, H. Browne, G. S. Rose, A. H. DeCherney. Program in Reproductive and Adult Endocrinology, NICHD, National Institutes of Health, Bethesda, MD; Department of Gynecologic Oncology, Walter Reed Army Medical Center, Washington, DC. OBJECTIVE: To present a novel surgical approach for fertility preservation in a true hermaphrodite who is status-post a unilateral salpingo-oophorectomy for an ovotestis with a gonadoblastoma. DESIGN: Case report. MATERIALS AND METHODS: 20-year-old nulliparous African-American female who was found to have a left ovotestis with a gonadoblastoma and intratubular germ cell neoplasia on pathology after undergoing an exploratory laparotomy and left salpingo-oophorectomy prior to admission for a persistent 9 cm complex left adnexal mass. A CT scan of her abdomen and pelvis did not reveal any evidence of metastatic disease and ovarian tumor markers were negative. Of note, she has had clitoromegaly since she was an infant, and moderate facial acne that developed after puberty. Endocrine studies were significant for an elevated serum total testosterone
Vol. 90, Suppl 1, September 2008