A significant increase in breast cancer (BC) rates has been observed among pre-menopausal woman. Considering the higher number of patients (pts) who have not completed their family planning and impact of age on fertility, fertility preservation (FP) is proving to be a major challenge. Gemme Dormienti Onlus (GD) is an italian association that helps pts by promoting a valid model of FP counselling. Our aim was to identify age influence on ovarian function (OF) and FP in BC pts.
We analyzed 100 BC pts referred to GD. Pts were stratified by age in 3 groups: group 1 (G1) 18-29 years (y) (N= 15), group 2 (G2) 30-35 y (N=39), group 3 (G3) 36-39 y (N=46). All pts underwent basal laboratory and instrumental tests. FP options were gonadotropin-releasing hormone agonists (GnRHa) and/or cryopreservation of oocyte and/or cryopreservation of ovarian tissue (OTC).
Basal follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH) and 17 beta-estradiol (E2) variations were affected by woman age in all groups [FSH (mU/ml): G1=3.6 (2.8-9.1), G2= 5.6 (1.5-12.4); G3= 5.9 (1.8-12.2); p= 0.323], [AMH (ng/ml): G1=6.0 (2.4-9.4); G2= 2.9 (1.0-7.6); G3= 4.0 (1.0-8.1); p= 0.099], [E2 (pg/ml): G1=89.0 (58.0-133.0), G2= 72.5 (11.0-511.3), G3= 50.8 (10.0-314.3), p=0.248]. Age-associated changes in antral follicular count (AFC) and endometrial thickness (ET) were clearly evident [Left-right AFC: G1=7.0 ± 3.1, 7.0 ± 5.3; G2= 4.0 ± 3.1, 4.0 ± 2.5; G3= 3.5 ± 2.5, 3.0 ± 4.2; p=<0.001, p=0.022], [ET (mm): G1=11.0 ± 2.9; G2= 9.0 ± 3.1; G3= 6.5 ± 3.0; p= 0.022]. All pts underwent GnRHa treatment, 30 pts oocyte cryopreservation (G1=40%, G2= 36.8%, G3=21.7%; p= 0.219); 18 OTC (G1=46.7%, G2=13.2%, G3=13%; p=0.008), 5 both techniques (G1=26.6%, G3=2.1). Lack of time (G2=15.8%; G3=12.9%), contraindications (G1=66.7%; G2= 47.4%; G3= 51.6%) and patient choice (G1=33.3%; G2= 36.8%; G3= 35.5%) were the main reasons for not starting FP. We observed 6 post-therapies pregnancies: 2 spontaneous in the G3 and 4 induced, 1 in G2 from OTC and 3 in G3 from oocyte cryopreservation.
Our data showed that FP counseling is a crucial need for BC premenopausal pts to express and realize the desire of pregnancy and improve a better quality of life.
The authors.
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All authors have declared no conflicts of interest.