Acute onset of ovarian dysfunction in young females after start of cancer treatment

Pediatr Blood Cancer. 2013 Apr;60(4):676-81. doi: 10.1002/pbc.24327. Epub 2012 Sep 26.


Background: Female childhood cancer survivors are at risk of ovarian failure and premature ovarian insufficiency. We hereby present an interim analysis of a prospective observational study of ovarian function during cancer treatment of young females in relation to clinical factors.

Procedure: Thirty-four consecutive female cancer patients aged 0-18 year were included after informed consent. Serum/Plasma levels of anti-Müllerian hormone (AMH), inhibin B, FSH, LH, and oestradiol (E2) were measured at diagnosis and every 3-4 months during and after treatment.

Results: All patients had detectable AMH levels at diagnosis. Eleven patients had reached menarche (mean age 14½ years) and the remaining patients had a mean age of 6½ years. They all showed a rapid decline in AMH after 3 months of treatment, regardless of AMH at diagnosis, age, menarche, or treatment given. Those given radiotherapy below the diaphragm and/or stem cell transplantation (SCT) (n = 9) had no ovarian recovery during or 1½-year after treatment. However, recovery was observed in those given standard treatment for acute lymphatic leukemia (n = 7) already during maintenance chemotherapy. For the remaining patients, longer follow-up is required for analysis of ovarian recovery after treatment.

Conclusions: Rapid ovarian dysfunction is observed in all females after initiation of cancer treatment as measured by AMH and inhibin B. Our data regarding those who require abdominal radiotherapy and/or SCT confirms the recommendations in the Nordic countries where these patients are eligible for cryopreservation of ovarian cortical tissue before start of cancer treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Mullerian Hormone / blood*
  • Antineoplastic Agents / adverse effects*
  • Child
  • Child, Preschool
  • Enzyme-Linked Immunosorbent Assay
  • Estradiol / blood
  • Female
  • Follicle Stimulating Hormone / blood
  • Humans
  • Inhibins / blood*
  • Luteinizing Hormone / blood
  • Neoplasms / drug therapy*
  • Primary Ovarian Insufficiency / chemically induced*


  • Antineoplastic Agents
  • inhibin B
  • Estradiol
  • Inhibins
  • Anti-Mullerian Hormone
  • Luteinizing Hormone
  • Follicle Stimulating Hormone