Fertility outcomes in women after therapy for non-Hodgkin lymphoma

Aim: To assess menstrual and reproductive function in women, who underwent treatment non-Hodgkin (NHL) lymphoma. Materials and methods: The study included 39 female patients diagnosed with NHL. All patients still had remission by the end of the study. To collect retroaspective data, a telephone survey of the women under the study was conducted, or the data were collected from their medical records. Results: Before conception, the patients underwent 3-4 or even more than 11 chemotherapy cycles. In one patient, menses never resumed after 14 cycles of chemotherapy. However, a single observation was not enough for making statistically significant conclusion. Most treatment regimens included highly gonadotoxic substances (Cyclophosphan in 94.87% of the cases, Doxorubicin and platinum-based drugs in 89.74%). R-CHOP was the most common regimen, which was used among the studied cohort. Regular menstrual cycle resumed after treatment in 82.05% of patients. Of them, 46.88% of women received combined oral contraceptive pills (COCP), and 9.38% received depot GnRH agonist (aGnRH) for ovarian protection. After treatment with COCP, 16.66% of patients had permanent amenorrhea. None of the patients, who were treated with depot aGnRH, had persistent amenorrhea. The median period of menstrual cycle restoration was 2.41 months. In 62.07% of women, who received COCP, menstruation restored immediately or 1 month after treatment. Restoration period was longer (1-2 months) in patients, who received depot aGnRH. In 34/48% of women, the episodes of ovarian dysfunction (oligomenorrhea) was observed. Spontaneous pregnancy rate was 82.76% among those who had menses. Pregnancy occurred in a period from 24 to 54 months after the completion of chemotherapy treatment. Infertility rate increased from 10.26 to 23.07%. Two patients got pregnant after undergoing ART treatment. 82.76% of women with restored menses spontaneously conceived 24 to 54 months after polychemotherapy. The rate of infertility among the treated women increased from 10.26% to 23.07%. Two patients became pregnant after IVF. Conclusion: The critical factors for restoration of menstrual function after treatment for non-Hodgkin lymphoma were; the age of patients, high ovarian reserve, chemotherapy duration and regimens. Recovery of menstrual cycle does not always result in restoration of fertility. Medical ovarian protection does not completely protect from gonadotoxic impact of polychemotherapy. Due to this, it is important that the patients with oncologic diseases should undergo examination by a gynecologist not only after being diagnosed with the oncologic disease, but also after treatment. Only cooperation between oncologists and gynecologists may contribute to correct prognosis, reduction of reproductive losses women’s understanding of their reproductive prospective.

non-Hodgkin lymphoma, oncofertility, ovarian protection, fertility preservation, chemotherapy, pregnancy