In a prospective study of female cancer survivors under age 40 years, self-opinions of fertility status based on menstrual cycle influenced quality of life (QoL) more strongly than did objective markers of ovarian reserve.

Laxmi A. Kondapalli, MD, MSCE, director of the University of Colorado Cancer Center Oncofertility Program in Denver, Colorado, and colleagues assessed QoL scores and possible association with ovarian reserve measures in 59 female cancer survivors aged 16 to 39 years. The primary outcome measures were the generic and cancer-specific domain scores on the Quality of Life in Adult Cancer Survivors (QLACS) instrument, early follicular phase serum hormones, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), inhibin B (INH), anti-Mullerian hormone (AMH), and the ovarian ultrasound measurements of ovarian volume and antral follicle count (AFC).

Kondapalli and associates presented their findings in the journal Quality of Life Research: Compared with 66 controls of similar age, the cancer survivors had significantly higher total and cancer-specific domain scores on the QLACS, suggesting that QoL is significantly impaired in cancer survivors compared with the general population.

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The survivors also had higher serum FSH levels, but lower serum AMH, INH, ovarian volume, and AFC. These markers of diminished ovarian reserve were not independently associated with total QLACS score, but survivors with irregular menstrual function were found to have lower QoL scores than those with regular cycles. 

“It wasn’t the lab and ultrasound markers of ovarian reserve alone that affected quality of life,” explained Kondapalli in a statement issued by the University of Colorado Denver. “It was a woman’s opinion of her fertility status based on her menstrual cycle that had the most impact on quality of life.”

According to Kondapalli, many women believe that if their menstrual cycles become irregular following cancer treatment, they are likely infertile due to treatment. However, “This isn’t necessarily the case, because we are finding that menstrual cyclicity is a poor predictor of fertility status in these young, female cancer survivors.”