Abstract
High survival rates of children diagnosed with cancer have led to a growing population of women with premature ovarian failure (POF) due to chemotherapy and radiotherapy. The POF process occurs due to the disruption of the hypothalamic-pituitary and gonadal axis followed by the delay of puberty development. Evaluation of reproductive function in children with cancer is essential to determine the fertility preservation plan. This study aimed to describe reproductive functions in children and adolescents with cancer who received chemotherapy based on Tanner stage evaluation, menstrual cycle, and anti-Mullerian hormone (AMH) examination using electro-chemiluminescence immunoassay kit. Twenty-three girls aged 12-18years old and had menarche who underwent cancer therapy in January-August 2019 in Dr. Sardjito General Hospital were included in the study. Among them, 61% had low AMH levels and were defined as diminished ovarian reserve (DOR). Two subjects with DOR experienced delayed puberty. Regular menstrual cycle was reported in 65.2% of subjects and irregular menstrual cycle in 34.8%, while 21.7% with irregular menstrual cycle encountered secondary amenorrhea. Chemotherapy exposure affected DOR occurrence in 60.9% of patients with childhood and adolescence cancer. Moreover, it also altered menstrual regularity in 34.8% and delayed puberty development in 8.7% subjects.
Highlights
High survival rate of children diagnosed with cancer has led to a growing population of women with premature ovarian failure (POF) due to chemotherapy and radiotherapy
Chemotherapy exposure impacted on Diminished Ovarian Reserve (DOR) occurrence in 60.9% childhood and adolescence cancer
Stratification for therapy risk was classified as low risk when received methotrexate, vincristine, actinomycin D, vinblastine, mercaptopurine, or hydroxyurea and high risk when the patient received cyclophosphamide as their treatment regimen
Summary
High survival rate of children diagnosed with cancer has led to a growing population of women with premature ovarian failure (POF) due to chemotherapy and radiotherapy. The increased survival rate in children with cancer has led to a growing population of women with premature ovarian failure (POF) due to radiotherapy and chemotherapy exposure in cancer treatment [2]. The disruption of this axis that occurs due to tumors, surgery, radiation, and chemotherapy, which are gonadotoxic, can cause endocrine disturbances that lead to disruption of the puberty process [8] This disruption of puberty can be measured with the Tanner Staging which is used to classify the development of secondary sex characteristics of children [9]
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