Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Fertil Steril. 2018 Mar;109(3):516-525.e1. doi: 10.1016/j.fertnstert.2017.11.016. Epub 2018 Feb 7.
To compare markers of fertility and ovarian reserve between cancer survivors and cancer-free women with and without polycystic ovary syndrome (PCOS).
Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women's Study-a population-based cohort study.
Not applicable.
PATIENT(S): Female cancer survivors (n = 1,090) aged 22-45 years, diagnosed between ages 20 and 35 years, and at least 2 years after diagnosis; 369 participated in a clinic visit. Three hundred seventy-four reproductive-aged women without cancer also completed a clinic visit.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Infertility, time to first pregnancy after cancer diagnosis, and measures of ovarian reserve (antimüllerian hormone [AMH] and antral follicle count [AFC]).
Seventy-eight cancer survivors (7.2%) reported a PCOS diagnosis, with 41 receiving gonadotoxic treatment. Survivors with PCOS exposed to gonadotoxic treatment (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.2-4.5) and unexposed (OR 3.4, 95% CI 1.7-6.9) were more likely to report infertility than unexposed survivors without PCOS and were more likely to have fewer children than desired (exposed: OR 2.1, 95% CI 1.0-4.2; unexposed: OR 3.0, 95% CI 1.4-6.8). After adjusting for age, comparison women with PCOS had the highest markers of ovarian reserve (AMH: 2.43 ng/mL, 95% CI 1.22-4.82 ng/mL; AFC: 20.7, 95% CI 15.3-27.8), and cancer survivors without PCOS treated with gonadotoxic agents had the lowest levels (AMH: 0.19 ng/mL, 95% CI 0.14-0.26 ng/mL; AFC: 7.4, 95% CI 6.4-8.5).
CONCLUSION(S): Despite having higher AMH and AFC on average after cancer treatment, cancer survivors with PCOS were less likely to meet their reproductive goals compared with survivors without PCOS.
比较癌症幸存者与患有和不患有多囊卵巢综合征（PCOS）的无癌症女性的生育和卵巢储备标志物。
进一步了解癌症、健康和成年幸存者（FUCHSIA）女性研究-一项基于人群的队列研究。
不适用。
年龄在 22-45 岁之间的女性癌症幸存者（n=1090），诊断年龄在 20 岁至 35 岁之间，且诊断后至少 2 年；其中 369 人参加了临床就诊。374 名生育年龄的无癌症女性也完成了临床就诊。
无。
不孕、癌症诊断后首次妊娠时间和卵巢储备标志物（抗缪勒管激素[AMH]和窦卵泡计数[AFC]）。
78 名癌症幸存者（7.2%）报告了 PCOS 诊断，其中 41 名接受了性腺毒性治疗。接受性腺毒性治疗的 PCOS 幸存者（比值比[OR] 2.3，95%置信区间[CI] 1.2-4.5）和未接受治疗的幸存者（OR 3.4，95% CI 1.7-6.9）更有可能报告不孕，并且比未接受 PCOS 治疗的无癌症幸存者更有可能拥有的孩子少于预期（暴露组：OR 2.1，95% CI 1.0-4.2；未暴露组：OR 3.0，95% CI 1.4-6.8）。在调整年龄后，患有 PCOS 的对照组女性的卵巢储备标志物（AMH：2.43ng/mL，95%CI 1.22-4.82ng/mL；AFC：20.7，95%CI 15.3-27.8）最高，而未接受性腺毒性药物治疗的无癌症 PCOS 幸存者的水平最低（AMH：0.19ng/mL，95%CI 0.14-0.26ng/mL；AFC：7.4，95%CI 6.4-8.5）。
尽管癌症治疗后平均 AMH 和 AFC 水平较高，但与无 PCOS 的幸存者相比，患有 PCOS 的癌症幸存者更有可能无法实现其生殖目标。
