Functional ovarian reserve in women with Hodgkin and non-Hodgkin lymphomas

Hematological malignancies may impair ovarian function even before chemotherapy begins, raising concerns about the effectiveness of oocyte cryopreservation. However, available evidence remains conflicting, partly because of confounding factors and suboptimal study designs. This study investigated whether women with lymphoma show reduced ovarian reserve or impaired ovarian response compared with women without cancer and women with non-hematologic malignancies.

We conducted a retrospective analysis of women with Hodgkin and non-Hodgkin lymphomas who underwent oocyte cryopreservation for fertility preservation at our Institution. Each patient was age- and study period-matched to two control groups: one comprising women without cancer undergoing Assisted Reproductive Technologies for infertility, allowing comparison of ovarian reserve markers (Anti-Müllerian Hormone, AMH, and antral follicle count, AFC), and another comprising women with non-hematologic solid tumors to compare ovarian stimulation outcomes.

The first comparison included 66 cases and 66 controls without cancer. Median [interquartile range - IQR] serum AMH was 1.97 [1.14-3.23] and 2.94 [2.12-4.60], respectively (p=0.002). However, AFC was similar (18 [12-24] versus 15 [11-21], p=0.16). The second comparison involved 74 cases and 74 non-hematologic cancer controls. Ovarian response was similar between groups, with a median [IQR] number of frozen mature oocytes of 10 [6-15] and 13 [6-16], respectively (p=0.56).

Early alterations in follicular function may occur in women with lymphoma. Nevertheless, ovarian response to stimulation appears preserved, supporting the effectiveness of fertility preservation.