Comparative Evaluation of Ovarian Reserve Following Cytotoxic Therapy for Breast Cancer Among Women in the Reproductive Age in Select Sites in Nairobi Kenya (a Comparative Cross-sectional Study)

Abstract

Inroduction: While advances in breast cancer therapies have led to improvements in long-term survival, treatments often lead to premature ovarian failure and sometimes infertility. Tthis is dependent on the age, dose and type of the agent. In evaluating the extent of this damage, Ovarian Reserve Testing (ORT) has become established as a pre and post chemotherapy fertility counselling tool and as a guide to the various treatment options. Despite paucity of data from developing countries, literature from the developed countries indicate promising results with the use of Anti Mullerian Hormone (AMH) to ovarian reserve. In addition to being relatively stable across the menstrual period, AMH appears to show significant comparable estimates of ovarian reserve across different populations. Objective: To evaluate the impact of cytotoxic therapy on ovarian reserve in patients in the reproductive age at least one year after chemotherapy for breast cancer at a select number of cancer treatment centres in Nairobi Methodology: This was a comparative cross-sectional study. Following Ethical approval from the KNH-UoN ERC, a total of 40 women attending breast cancer clinics and meeting the inclusion criteria were selected from three cancer treatment centres in Nairobi (Kenyatta National Hospital, 22; The Texas Cancer Centre, 12 and the Nairobi Radiotherapy and Cancer Centre, 6). A comparative group of 40 women, matched for age (+/1 3years) were identified from the ‘well woman clinic 66’ at the Kenyatta National Hospital Clinic. Data was collected using an interviewer guided questionnaire administered to the participants; clinical data was abstracted from the patients’ files. Two ml of venous blood was drawn by principal investigator or trained research assistant and taken to the Lancet laboratory for evaluation of AMH levels. Data was cleaned and analyzed using SPSS Version 23 software..................................................................................