ECE2013 Poster Presentations Female reproduction (47 abstracts)
Ovarian function is associated with obesity in very long-term female survivors of childhood cancer
Wendy van Dorp 1, , Karin Blijdorp 1, , Joop Laven 2 , Rob Pieters 1 , Jenny Visser 4 , Aart-Jan van der Lely 3 , Sebastian Neggers 1, & Marry van den Heuvel-Eibrink 1
1Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands; 2Department of Gynecology and Obstetrics, Subdivision Reproductive Medicine, Erasmus MC–University Medical Center, Rotterdam, The Netherlands; 3Department of Medicine – section Endocrinology, Erasmus MC–University Medical Center, Rotterdam, The Netherlands; 4Department of Internal Medicine, Erasmus MC–University Medical Center, Rotterdam, The Netherlands.
Introduction: Obesity and gonadal dysfunction are major side effects of treatment in adult childhood cancer survivors. In the general population, obesity has a negative influence on female fertility. The aim of the study was to evaluate whether obesity and serum insulin are associated with decreased ovarian reserve markers in childhood cancer survivors.
Methods: We performed a retrospective single-center cohort study in 191 adult female survivors of childhood cancer. Median age at follow-up was 27.1 (range 17.7–50.0) years and median follow-up time was 18.8 (2.3–48.8) years. Outcome measures were serum levels of anti-Müllerian hormone (AMH) and total follicle count (FC) and – if measured during early follicular phase or amenorrhoea – antral follicle count (AFC). Potential risk factors were body mass index (BMI), body composition measures, determined by dual energy X-ray absorptiometry (total fat percentage, lean body mass and visceral fat percentage) and fasting insulin. Multiple linear regression analysis, adjusted for potential confounders, was used to evaluate the associations between potential risk factors and serum AMH and FC.
Results: Lower serum AMH was found in obese subjects (β (%) −49, P=0.007), and in subjects with fasting insulin in the highest tertile (β (%) −43, P=0.039). Total fat percentage tends to be associated with serum AMH (β (%) −2.1, P=0.06). Survivors in the highest tertile of insulin had significant lower FC than survivors in the lowest tertile (β −6.3, P=0.013). BMI and other measures of body composition were not associated with FC. Correlation between serum AMH and AFC was ρ=0.32 (P=0.08).
Conclusions: Obesity and insulin resistance are associated with gonadal damage, as reflected by decreased AMH and reduced FC in adult survivors of childhood cancer. In contrast to its highly predictive value for AFC in the healthy female population, serum AMH does not seem to correlate as well with AFC in childhood cancer survivors.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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