It has been reported by us and by others that after chemotherapy for Hodgkin's disease the ovary contains fewer than 5 primordial and primary follicles per 5 x 5 mm biopsy section. In young women this is associated with premature menopause. We report here that before treatment the tissue contains 18--55 such follicles per biopsy section. When women took combination oral contraceptives throughout the course of MVPP therapy, the posttreatment ovarian biopsy tissue had more than 20 follicles per histologic section. Normal menses were established in the five women who discontinued oral contraceptives at the end of MVPP therapy, and one of them is now pregnant.
PIP: The study objective was to determine if suppression of ovarian function by oral contraceptives (OCs) would provide protection against ovarian cell death secondary to chemotherapy. By means of menstrual history, serum gonadotropin levels, and ovarian biopsy, ovarian function was evaluated in 6 young women with untreated Hodgkin's disease. The women ranged in age from 18 to 31 years at onset of treatment. Each woman was given a standard 6 cycles of MVPP therapy (nitrogen mustard, vinblastine, procarbazine, and prednisone). At the time of initiation of MVPP therapy, they were placed on the combination OCs Norlestrin or Ovran on the usual schedule for birth control. 6-12 weeks after the last cycle, 3 women were biopsied and the menstrual history was repeated in all cases. This followup was repeated at intervals of 4-12 months, the most recent in April 1981, range 20-29 months, median 26 months. 5 ovarian biopsies obtained prior to therapy contained 18-55 primordial and primary follicles. Posttherapy ovarian biopsies were performed on 3 of the 6 women who had been treated with OC while they were receiving the 6 cycles of MVPP therapy. The ovary specimens revealed 22, 1000, and 22 primordial and primary follicles per section. Normal menses were established in the 5 women who discontinued OCs at the end of MVPP therapy, and 1 of them is currently pregnant. The pregnancy and the regular menses in the 3 women not on hormonal agents up to 2 years after stopping MVPP therapy encourages the belief that these women will not experience premature menopause in a few years' time. Particularly hopeful is the normal ovarian function of the 30-year-old woman, the woman who was at greatest risk for chemotherapy-induced ovarian failure.