Ovarian function is associated with obesity in very long-term female survivors of childhood cancer

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 554-573-Ovarian & Uterine Function I
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-564
Karin Blijdorp*1, Wendy van Dorp2, Joop S E Laven2, Rob Pieters3, Jenny A. Visser4, Aart Jan Van der Lely5, Sebastian JCMM Neggers6 and Marry van den Heuvel7
1Erasmus University Medical Centre, Rotterdam, Netherlands, 2Erasmus MC University Medical Center, Rotterdam, Netherlands, 3Erasmus MC University Medical Center - Sophia's Children's Hospital Rotterdam, 4Erasmus MC, Rotterdam, Netherlands, 5Erasmus University Medical Center, Rotterdam, Netherlands, 6Erasmus MC, Netherlands, 7Erasmus MC-Sophia Children’s Hospital

Obesity and gonadal dysfunction are known major side effects of treatment in adult childhood cancer survivors. In the general population, obesity has a negative influence on female fertility. The aim of the study was to evaluate whether obesity and serum insulin are associated with decreased ovarian reserve markers in childhood cancer survivors.


We performed a retrospective single-center cohort study in 191 adult female survivors of childhood cancer. Median age at follow-up was 27.1 years (range 17.7-50.0) and median follow-up time was 18.8 years (2.3-48.8). Outcome measures were serum levels of anti-Müllerian hormone (AMH) and total follicle count (FC) and if measured during early follicular phase or during amenorrhoea antral follicle count (AFC). Potential risk factors were body mass index (BMI), body composition measures, determined by dual energy X-ray absorptiometry (total fat percentage, lean body mass and visceral fat percentage) and fasting insulin. Multiple linear regression analysis, adjusted for potential confounders, was used to evaluate the associations between potential risk factors and serum AMH and FC.


Lower serum AMH was found in obese subjects (ß (%) -49, P=0.007), and in subjects with fasting insulin in the highest tertile (ß(%) -43, P=0.039). Total fat percentage tends to be associated with serum AMH (ß(%) -2.1, P=0.06). Survivors in the highest tertile of insulin had significant lower FC than survivors in the lowest tertile (ß -6.3, P=0.013). BMI and other measures of body composition were not associated with FC. Correlation between serum AMH and antral follicle count (AFC) was ρ=0.32 (P=0.08).


Obesity and insulin resistance are associated with gonadal damage, as reflected by decreased AMH and reduced FC in adult survivors of childhood cancer. In contrast to its highly predictive value for AFC in the healthy female population, serum AMH does not seem to correlate as well with AFC in childhood cancer survivors.

Disclosure: JSEL: Researcher, Ferring Pharmaceuticals, Researcher, Merck BV, Founder, Genovum. Nothing to Disclose: KB, WV, RP, JAV, AJV, SJN, MV

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm