P-665 Fertility in female patients treated for Hodgkin’s lymphoma
Authors: Dmitrieva I , Nazarenko T , Polushkina E , Khokhlova S , Shpirko V , Tumyan G , Martirosyan Y , Sukhih G 
Published: June 2022

Abstract

Study question
we aimed to determine factors which could possibly predict future ability to conceive in patients that are to be treated for Hodgkin's lymphoma.

Summary answer
we identified the key characteristics for high probability to achieve a spontaneous pregnancy: younger age, high ovarian reserve and GnrH-a or COC during chemotherapy.

What is known already
Hodgkin's lymphoma is considered one of the most aggressive yet successfully treatable oncological diseases. Prevalence among younger patients and highly gonadotoxic chemotherapy regimens bring up a question of fertility preservation. The issue of predicting the future fertility potential of patients who will have undergone chemotherapy treatment is unresolved to this day. Determining the influence of different factors would allow the creation of personalized fertility preservation treatment plans for each patient.

Study design, size, duration
This observational study was conducted at the V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology. It included 149 patients of reproductive age diagnosed with Hodgkin's lymphoma who had indications to chemotherapy. All of the patients signed an informed consent form prior to participation.

Participants/materials, setting, methods
The study included 149 participants with a mean age of 23 ± 6.08 years. All of the participants underwent chemotherapy either without (68.09%) or with ovarian protection (OP) (31.91%). The prevalent chemotherapeutic agents were Adriamycin, Oncovin and Bleomycin. The median number of cycles was 6 ± 2.62.

Main results and the role of chance
Out of all patients 18 had a recurrence and only one died. One patient had three recurrences but after treatment she resumed her menstrual function, achieved one spontaneous pregnancy and live birth. This patient was only 21 years old with very high antral follicular count and had a very short period between recurrences, that way her treatment was performed with continuous GnRH-a protection. Out of patients without OP, 44.8% lost their menstrual function and later had to undergo assisted reproduction treatment, including oocyte donation. Menstrual function recovery rate was higher in both groups with GnRH-a and COC - 80% and 84%, respectively – but not high enough to be statistically significant. Time to recovery was 2 ± 2.57 months, with no significant difference between groups with COC, GnRH-a or without any protection. Patients aged 30 and older had a lower menstruation recovery rate (33.33%) compared to 71.08% and 75% for those younger than 30 and 20, respectively. Two more patients were prepubescent and therefore were not included in the statistical analysis but showed normal regular menses after menarche and achieved spontaneous pregnancies.

Limitations, reasons for caution
Despite aforementioned results the quantity of factors does not let us draw compelling conclusions about their degree of influence; this way multifactorial analysis with more participants would be more preferable. A higher rate of pregnancies in OP group could also correlate with higher alertness and therefore earlier attempts to conceive.

Wider implications of the findings
our findings demonstrate the need for and possibility of predictive model development. This would provide an opportunity not only to establish fertility preservation treatment options but also help in reproductive planning for those who have completed their main treatment, taking the risk of POI into consideration.

Trial registration number
not applicable