1. A Novel Ovarian Reserve Monitoring Algorithm for Patients at Risk of Ovarian Injury from Gonadotoxic Therapy

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Journal of pediatric and adolescent gynecology Pub Date : 2025-02-28 DOI:10.1016/j.jpag.2025.01.013
Guluzar Turan , Victoria Kennerley , Marie-Teresa Colbert , Marcy Hoath , Kamilah Abdur-Rashid , Mikayla Ecker , Mary Sammel , Leslie Appiah
{"title":"1. A Novel Ovarian Reserve Monitoring Algorithm for Patients at Risk of Ovarian Injury from Gonadotoxic Therapy","authors":"Guluzar Turan ,&nbsp;Victoria Kennerley ,&nbsp;Marie-Teresa Colbert ,&nbsp;Marcy Hoath ,&nbsp;Kamilah Abdur-Rashid ,&nbsp;Mikayla Ecker ,&nbsp;Mary Sammel ,&nbsp;Leslie Appiah","doi":"10.1016/j.jpag.2025.01.013","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Adolescent and young adult cancer survivors are at risk of infertility due to the gonadotoxic effects of treatment. Although ovarian function testing (OFT) is an essential aspect of fertility care, there is currently no standard of care for monitoring reserve after gonadotoxic therapy. At our institution, we measure AMH and FSH at 12-, 18-, and 24-months post-therapy for early detection of DOR (diminished ovarian reserve) and POI (premature ovarian insufficiency) to avoid delays in referral for assisted reproductive technologies (ART). The primary objective of this study is to assess whether a novel ovarian reserve monitoring algorithm enables early detection of DOR and POI after gonadotoxic therapy to improve reproductive outcomes.</div></div><div><h3>Methods</h3><div>In this IRB-approved observational cohort study at University of Colorado Hospital, we evaluated the algorithm to (1) identify survivors at risk of DOR and POI due to gonadotoxic therapy and (2) minimize time from treatment to ART. Group A (n=106) consisted of a retrospective cohort of survivors who completed therapy between October 1, 2016, and September 31, 2019, with AMH and FSH evaluated at 12, 18, and 24 months post-treatment completion (n=27). Group B (n=418) included survivors who completed cancer therapy after September 31, 2019, assessed prospectively at similar time points (n=64). AMH and FSH values, along with time since treatment, were analyzed to determine if the algorithm enables early detection of DOR before POI. Ovarian status was categorized as normal, diminished, impending POI, or POI. Time from treatment to diagnosis of DOR and POI was compared between the prospective group and historical controls using the log-rank test.</div></div><div><h3>Results</h3><div>Demographics between groups A and B were similar. OFT within 36 months after completing cancer treatment was performed in only 17.4% (91/524) of patients, and AMH was rarely tested before 2019. At the 24-month follow-up, the prospective group had a higher prevalence of normal ovarian reserve (44.3% [27/61] vs. 17% [4/23], p=0.05) compared to the retrospective group. Time from treatment to diagnosis of DOR or POI was shorter in Group B, although not significantly due to the small sample size (8.2 months in group A [n=19] vs. 6.1 months in group B [n=24], p=0.7).</div></div><div><h3>Conclusions</h3><div>Results suggests that patients followed under the fertility preservation program since 2019 have received more frequent monitoring and earlier OFT with increased use of AMH testing to detect changes before significant decline. The ovarian reserve monitoring algorithm allows early detection of DOR and POI after gonadotoxic therapy, potentially improving reproductive outcomes.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 219"},"PeriodicalIF":1.7000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pediatric and adolescent gynecology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1083318825000336","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background

Adolescent and young adult cancer survivors are at risk of infertility due to the gonadotoxic effects of treatment. Although ovarian function testing (OFT) is an essential aspect of fertility care, there is currently no standard of care for monitoring reserve after gonadotoxic therapy. At our institution, we measure AMH and FSH at 12-, 18-, and 24-months post-therapy for early detection of DOR (diminished ovarian reserve) and POI (premature ovarian insufficiency) to avoid delays in referral for assisted reproductive technologies (ART). The primary objective of this study is to assess whether a novel ovarian reserve monitoring algorithm enables early detection of DOR and POI after gonadotoxic therapy to improve reproductive outcomes.

Methods

In this IRB-approved observational cohort study at University of Colorado Hospital, we evaluated the algorithm to (1) identify survivors at risk of DOR and POI due to gonadotoxic therapy and (2) minimize time from treatment to ART. Group A (n=106) consisted of a retrospective cohort of survivors who completed therapy between October 1, 2016, and September 31, 2019, with AMH and FSH evaluated at 12, 18, and 24 months post-treatment completion (n=27). Group B (n=418) included survivors who completed cancer therapy after September 31, 2019, assessed prospectively at similar time points (n=64). AMH and FSH values, along with time since treatment, were analyzed to determine if the algorithm enables early detection of DOR before POI. Ovarian status was categorized as normal, diminished, impending POI, or POI. Time from treatment to diagnosis of DOR and POI was compared between the prospective group and historical controls using the log-rank test.

Results

Demographics between groups A and B were similar. OFT within 36 months after completing cancer treatment was performed in only 17.4% (91/524) of patients, and AMH was rarely tested before 2019. At the 24-month follow-up, the prospective group had a higher prevalence of normal ovarian reserve (44.3% [27/61] vs. 17% [4/23], p=0.05) compared to the retrospective group. Time from treatment to diagnosis of DOR or POI was shorter in Group B, although not significantly due to the small sample size (8.2 months in group A [n=19] vs. 6.1 months in group B [n=24], p=0.7).

Conclusions

Results suggests that patients followed under the fertility preservation program since 2019 have received more frequent monitoring and earlier OFT with increased use of AMH testing to detect changes before significant decline. The ovarian reserve monitoring algorithm allows early detection of DOR and POI after gonadotoxic therapy, potentially improving reproductive outcomes.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
3.90
自引率
11.10%
发文量
251
审稿时长
57 days
期刊介绍: Journal of Pediatric and Adolescent Gynecology includes all aspects of clinical and basic science research in pediatric and adolescent gynecology. The Journal draws on expertise from a variety of disciplines including pediatrics, obstetrics and gynecology, reproduction and gynecology, reproductive and pediatric endocrinology, genetics, and molecular biology. The Journal of Pediatric and Adolescent Gynecology features original studies, review articles, book and literature reviews, letters to the editor, and communications in brief. It is an essential resource for the libraries of OB/GYN specialists, as well as pediatricians and primary care physicians.
期刊最新文献
Maternal factors during pregnancy and pubertal timing in offspring: A systematic review of the literature. Table of Contents Editorial Board 57. Intralesional Cidofovir: A Promising Treatment for Refractory Genital Warts in Pediatric Patients 58. Is Reproductive Health Knowledge Protective Against Adolescent Pregnancy?
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1