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A prospective, observational study of chemotherapy-induced ovarian damage on follicular reserve and maturation

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Chemotherapy negatively affects gonadal function, often resulting in premature ovarian failure (POF) due to ovarian reserve depletion. Mechanisms of gonadotoxicity, such as primordial follicle overactivation and “burnout”, remain to be established. Ovarian tissue cryopreservation (OTC) before treatment plays an important role in safeguarding fertility.

Methods

This is a prospective observational study that aims to evaluate the feasibility of OTC after chemotherapeutic treatment initiation. Patients were divided into 2 groups depending on whether they received chemotherapy before the harvesting procedure (Group 1) or not (Group 2). The main outcomes of this study are serum anti-Mullerian hormone (AMH) levels and histological follicular counts on ovarian tissue biopsies.

Results

Between 2012 and 2020, 79 patients underwent OTC at our Hospital. Follicular counts from the ovarian biopsies of 30 post-pubertal patients and respective serum AMH levels were included in the analysis. AMH levels did not significantly differ between the 2 groups (P = 0.70) as well as the number of primordial follicles (P = 0.73). Ovarian biopsies of patients from Group 1 showed a higher number of primary follicles (P = 0.04) and atretic follicles (P = 0.05) with respect to Group 2.

Conclusions

In conclusion, OTC appears to be feasible even after the start of chemotherapeutic treatment, since in treated patients, the main ovarian reserve indicators (number of primordial follicles and serum AMH levels) were not significantly reduced compared to untreated patients. The “burnout” theory of chemotherapeutic damage to the ovary seems to be supported by the higher number of primary follicles found in the ovaries of patients who received chemotherapy before OTC.

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Funding

The authors have not received any funding to support this study.

Author information

Authors and Affiliations

  1. Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Raffaella Cioffi, Laura Cervini, Enrico Papaleo, Alice Bergamini, Stefano Ferrari, Giorgia Mangili & Massimo Candiani

  2. Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Gianluca Taccagni

  3. Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, San Raffaele Scientific Institute, Milan, Italy

    Luca Pagliardini

Authors
  1. Raffaella Cioffi
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  2. Laura Cervini
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  3. Gianluca Taccagni
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  4. Enrico Papaleo
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  5. Luca Pagliardini
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  6. Alice Bergamini
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  7. Stefano Ferrari
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  8. Giorgia Mangili
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  9. Massimo Candiani
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Contributions

RC’s roles included conceptualization, formal analysis and manuscript drafting; GM. contributed to conceptualization, critical discussion of data and manuscript review; GT. and LC performed data curation and formal analysis, and contributed to manuscript drafting; LP, EP, AB, SF and MC contributed to critical discussion of data and manuscript review. All authors read and approved the final version of the manuscript. The present work was performed by RC in partial fulfillment of the requirements for obtaining the PhD degree at Vita-Salute San Raffaele University, Milano, Italy.

Corresponding author

Correspondence to Raffaella Cioffi.

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The authors have no conflict of interest relevant to the present study.

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Cioffi, R., Cervini, L., Taccagni, G. et al. A prospective, observational study of chemotherapy-induced ovarian damage on follicular reserve and maturation. Arch Gynecol Obstet 306, 1723–1729 (2022). https://doi.org/10.1007/s00404-022-06692-0

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  • DOI: https://doi.org/10.1007/s00404-022-06692-0

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