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Gonadotropin-releasing hormone analogs (GnRHa) can reverse the trend of ovarian reserve alterations after chemotherapy.

The protection of ovarian function and the prevention of treatment-related reproductive damage in women with cancer will continue to be a pressing concern now and in the future. Oncologists and gynecologists have paid attention to this issue and developed clinical diagnoses and treatment guidelines. This issue is of particular importance in breast cancer treatment, as chemotherapy and hormone therapy may be associated with reproductive toxicity in many young breast cancer patients and decrease their ovarian function. As a particular reproductive hormone and an indication of ovarian reserve, the role of anti-Müllerian hormone (AMH) in premenopausal women with breast cancer warrants additional research.

This comprehensive analysis of the data from the EGOFACT study was published in The Breast. This phase III randomized controlled trial included premenopausal female breast cancer patients divided into two parallel groups: chemotherapy with or without gonadotropin-releasing hormone analogs (GnRHa). This study comprised 330 premenopausal women between the ages of 25 and 49 with operable stage I to III breast cancer. The characteristics of ovarian reserve alterations marked by AMH in the EGOFACT research and the factors influencing ovarian function in premenopausal women with breast cancer were analyzed.

The AMH level in the chemotherapy only group decreased gradually over the course of one year, whereas the AMH level in the GnRHa group was significantly higher compared to the control as early as six months after chemotherapy and recovered to a level close to the baseline level 12 months after chemotherapy (F = 34.991, P 0.001). Analysis of correlation revealed that age, menarche age, body mass index (BMI), reproductive history, baseline follicle stimulating hormone (FSH) level, pathological stage, and GnRHa application were the most influential factors on AMH levels, but they had different effects on the incidence of premature ovarian insufficiency (POI) at different time points. Menarche age of less than 14 years (OR 0.470 [0.259, 0.852], P = 0.013), baseline AMH level greater than 0.5 ng/mL (OR 9.590 [3.366, 27.320], P 0.001), pathological stage I (OR 0.315 [0.124, 0.798], P = 0.015), and GnRHa administration (OR 0.090 [0.045, 0.09]; P 0.001) were independent factors found to be conducive to the protection of ovarian reserve.

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According to this study, GnRHa can reverse the trend of ovarian reserve alterations after chemotherapy. The study also examined the dynamic variations in AMH and its influencing factors from many perspectives, which aids in the knowledge of ovarian function damage and protection. Using AMH <0.5 ng/mL as a quantitative indicator of POI can correctly reflect ovarian function loss and recovery following chemotherapy.

This study concluded that age, menarche age, baseline AMH level, and GnRHa administration are the most influential factors for ovarian reserve in premenopausal breast cancer patients. 

Reference:

Zong, X., Yu, Y., Chen, W., Zong, W., Yang, H., & Chen, X. (2022). Ovarian reserve in premenopausal women with breast cancer. Breast, 64, 143-150. https://doi.org/10.1016/j.breast.2022.05.009