There are currently over 250,000 survivors of childhood cancer in the U.S. Recent diagnostictherapeutic advances in pediatric oncology have led to greater survival rates in children and young adultswith malignancies. However, while cancer therapies improve long-term survival, such treatments can lead toimpaired fertility potential and eventual premature ovarian failure. The gonadotoxic effects ofchemotherapeutic agents are well documented, particularly for alkylating agents such as cyclophosphamideand appear to be dose dependent. However, while reduced reproductive potential has been recognized formany years, little information is known about the endocrinology of hypothalamic-pituitary-gonadal function inadolescents and young adults with cancer prior to, during, and after treatment. In the infertility setting,several clinical tests, including serum hormone measures and ultrasound measures of the ovaries, havebeen developed and are routinely used as surrogate markers to evaluate a woman's fertility potential and forcounseling regarding treatment options. In addition, there is emerging data that markers of oxidative stressmay reflect ovarian aging. However, it has not been established that such ovarian function testing can detectdiminished fertility potential in young female cancer patients during and after cancer treatment. Earlydetection of decreased fertility potential in cancer survivors would help to identify individuals who wouldbenefit from aggressive treatment with existing assisted reproductive technologies and emerging novelfertility preserving methods while there is still a chance of a successful pregnancy.The current proposal represents a comprehensive and novel investigation to assess measuifertility potential in adolescent and young adult cancer survivors.
The aims are two fold: to compare existingand novel surrogate measures of fertility potential between young female cancer survivors and healthycontrols, and to assess changes in existing and novel surrogate measures of fertility potential during andafter chemotherapy in young cancer patients. Measures of fertility potential to be tested include ultrasoundimaging, endocrine evaluation, and assessment of oxidative stress.This proposal will assist in establishing a protocol for evaluating ovarian reserve in female pediicancer survivors. Specifically, the results of this proposal will serve as preliminary data for the establishmentof a long term cohort study of pediatric cancer survivors to examine the association between thesemeasures and pregnancy rates, pregnancy outcomes and the occurrence of premature menopause.
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