New insights in the selection and management of cancer patients applicants for ovarian tissue cryopreservation

Abstract

Ovarian tissue cryopreservation (OTC), representing a promising strategy to preserve ovarian function in cancer patients, is recommended to women younger than 35 years. This study aimed to identify endocrine and biometric parameters as additional selection criteria for OTC. One hundred and ninety-one cancer patients before chemoradiotherapy and OTC and 43 controls were investigated. Mean ± SD, median, quartiles, 5th and 95th centiles and correlations of FSH, LH, estradiol, inhibin-B, anti-Mullerian hormone (AMH), ovarian volume and antral follicle count (AFC) were assessed. Most ovarian reserve parameters presented typical variations of ovulatory menstrual cycle, except AMH and AFC showing minimal fluctuations across the menstrual cycle. The 5th centiles of AMH (0.31and 0.4 ng/mL in controls and cancer patients, respectively) and AFC (five follicular structures in both groups) could be conjectured as minimum thresholds to include patients aged <35 years in OTC; below this threshold patients of any age should be excluded from OTC. Conversely, patients with AMH and AFC above the 25th centiles (1.2–1.6 ng/mL and 9–10 follicular structures in controls and cancer patients, respectively) might be inserted in OTC regardless of age. Baseline assessment of AMH and AFC might be considered as selection criteria, in addition to chronological age, to take decision of OTC in cancer patients.

Chinese abstract

卵巢组织冻存 (OTC) , 是癌症患者保护卵巢功能的有希望的策略, 适合35岁以下的女性。本研究旨在确定作为OTC选择的额外的激素和生物测定标准。在放化疗和OTC之前调查研究了191例癌症患者和43例对照。评估FSH, LH, 雌二醇, 抑制素-B, 抗缪勒管激素 (AMH) , 卵巢体积和窦卵泡计数 (AFC) 的平均数±SD, 中位数, 四分位数, 第5和第95百分位数和相关系数。除了AMH和AFC在月经周期显示很小的波动外, 大多数卵巢储备功能参数呈现典型排卵性月经周期的变化。小于35岁患者行OTC的最小限度预测为AMH的第5百分位数 (对照组和癌症患者组中分别为0.31和0.4ng/mL) 以及AFC (两组中都有五个卵泡结构) 的第5百分位数；低于此阈值的任何年龄的患者都不应行OTC。相反, AMH和AFC高于第25百分位数 (对照组和癌症患者组分别为1.2-1.6ng/mL及9-10个卵泡结构) 可以不考虑年龄行OTC。AMH和AFC的基线评估可以认为是除实际年龄外,癌症患者是否行OTC的选择标准。

Keywords:

• Anti-Mullerian hormone
• antral follicle count
• cancer
• cryopreservation
• ovarian tissue

Acknowledgements

We are grateful to all members of the medical and nursing staff of our Medical School who participated in the study as volunteers.

Declaration of interest

The authors report no declarations of interest.

This work was supported in part by grant from Ministero dell’Istruzione, dell’Università e della Ricerca, Rome, Italy (funds RFO ex-60% to R.P. and R.F.).