Assessment of ovarian reserve in girls diagnosed with pediatric cancer: a presentation of baseline data from a prospective follow-up study

Background Overall survival for childhood cancer continues to improve, and with a large proportion of patients reaching reproductive age the question of fertility is becoming increasingly important. The long-term side effects of cancer treatment can include reduced reproductive function. The aim of this study is to present the baseline data from inclusion of a prospective follow-up study of fertility surveillance in children diagnosed with cancer. We are striving to evaluate whether anti-mullerian hormone (AMH) could be used as a surveillance modality in prospective monitoring of ovarian reserve in female childhood cancer survivors. Methods Participants aged 0–17 years were enrolled at the Pediatric Oncology Center at Sahlgrenska University Hospital in Gothenburg, Sweden, between May 2016 and March 2021. Inclusion criteria were new diagnosis of pediatric cancer and scheduled treatment with chemotherapy and/or radiotherapy. The cohort will be part of a longitudinal follow-up program until the patients are approximately 25 years old; at this age puberty has passed and ovarian reserve in adult age can be evaluated. AMH levels are measured at inclusion and then every 2 years. Fertility preservation treatment will be offered in appropriate cases. Results After initial assessment of data, 74 participants were included in the study. The mean age was 7.7 years (median 8). The most common type of cancer was solid tumors ( n = 24), followed by leukemia ( n = 21). The baseline data showed initial levels of AMH between 0.03 and 9.97 μg/L, with a mean value of 1.7 μg/L and a median value of 1.1 μg/L. Fifty-six participants had AMH measured before cancer treatment started, and 18 had AMH levels taken after initiation of cancer therapy. Age-adjusted AMH values were on average 79% lower in patients who had already been exposed to cancer treatment compared with the untreated group. Two patients were offered fertility preservation before initiation of cancer therapy. Conclusion This is a presentation of the baseline data from a planned long-term follow-up study. The long-term study has a unique prospective design that will follow girls from cancer diagnosis through their adolescence and up to fertile age, including an assessment of AMH levels. This may enable identification of who would be likely to benefit from fertility preservation, and when.