Evaluation of ovarian functions in girls treated for hematological malignancy

Acute lymphoblastic leukemia (ALL) and other hematological malignancies are the most common cancers in children, with chemotherapy and/or radiotherapy as the primary treatment options. These treatments, however, may have long-term effects on ovarian function and fertility in female survivors. This study aims to evaluate ovarian function and reserve in female survivors of childhood hematological malignancies by assessing hormonal markers and ovarian follicle count. This cross-sectional study included 30 female survivors of acute leukemia, non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL) who completed chemotherapy between 2013 and 2023. Hormonal markers including anti-Müllerian hormone (AMH), inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and ovarian follicle counts were measured. Statistical analysis was performed using SPSS, with a significance level of p < 0.05. Out of 263 patients diagnosed with hematological malignancies during the study period, 30 female patients were included. The median age at diagnosis was 14 years (range: 7-24 years). The malignancy breakdown was as follows: 7 patients (23.3%) with ALL, 2 patients (6.7%) with acute myeloid leukemia (AML), 9 patients (30%) with HL, and 12 patients (40%) with NHL. The median number of right ovarian follicles was 6 (range: 0-13), and the median number of left ovarian follicles was 7 (range: 2-12), with a total median follicle count of 12.5 (range: 5-25). AMH levels were normal in 26 patients (86.7%) and low in 3 patients (10%), with 3 patients (10%) diagnosed with decreased ovarian reserve (DOR), defined by AMH levels < 0.96 ng/mL. Inhibin-B levels were normal in 25 patients (83.3%), elevated in 1 patient (3.3%), and low in 4 patients (13.3%). Significant correlations were found between AMH and inhibin-B (p = 0.005, r = 0.508), FSH and inhibin-B (p = 0.041, r = 0.375), and inhibin-B and total follicle count (p = 0.014, r = 0.444). Additionally, a significant modarate correlation between AMH levels and total follicle count was observed (p = 0.033, r = 0.396). The evaluation of ovarian reserve using AMH, inhibin B, and ovarian follicle counts provides critical insights for fertility planning in survivors of childhood cancer. Early and comprehensive assessments may improve reproductive outcomes and quality of life for these patients.