OC14.06: The role of antral follicle counts (AFC) via TVUSG in determining fertility preservation outcomes in cancer patients undergoing ovarian stimulation

Abstract

Objectives: Chemotherapy damages ovarian reserve and induces premature ovarian failure. It has been shown that menstrual status, and cycle day 2 (CD2) FSH and estradiol (E2) levels are not reliable for the assessment of chemotherapy effects on fertility. The purpose of this study was to determine whether antral follicle count (AFC) is predictive for ovarian stimulation outcomes in pre(COH) and postchemotherapy (PCCOH) patients undergoing fertility preservation with oocyte or embryo freezing. Methods: This was a prospective study of 69 COH and 16 PCCOH women who underwent controlled ovarian hyperstimulation while AFC, anti-mullerian hormone (AMH), FSH and E2 were obtained on CD2. The predominant diagnosis was breast cancer (n = 74, 62 COH vs. 12 PCCOH). PCCOH patients received a variety of alkylating agents. Results: Total (14.4 ± 1.3 vs. 8.0 ± 1.1) and mature (9.7 ± 0.8 vs. 5.9 ± 0.9) oocytes retrieved and two pronuclear (2PN) embryos generated (7.7 ± 0.7 vs. 5.1 ± 0.8) were significantly higher for COH vs. PCCOH patients (P < 0.05). The mean age at time of stimulation, CD2-FSH, and E2 were not significantly different. AFC (13.1 ± 1.3 vs. 8.7 ± 1.2) and AMH (2.6 ± 0.4 vs. 1.1 ± 0.5) were significantly higher in the COH group (P < 0.05). Linear regression analysis for COH but not PCCOH patients demonstrated a significant positive correlation for AFC and AMH in predicting the number of total oocytes, mature oocytes and 2PN embryos (P < 0.05). Multivariate regression analysis using AFC and AMH improved prediction of these patient outcomes (R2 = 0.53). Conclusions: The results of this study demonstrated that after chemotherapy, CD2-FSH and E2 were unaltered but AMH, AFC and stimulation outcomes were significantly lower. The combined use of AFC and AMH showed a strong correlation for predicting stimulation outcomes in COH patients but further investigation is needed for PCCOH patients. Fertility preservation consultation, as well as AFC and AMH, for patients prior to chemotherapy may improve prediction of patient outcome.