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17 The patient with previous pelvic irradiation
Vishvanath C. Karande
Department of Reproductive Endocrinology and Infertility, InVia Fertility Specialists, Hoffman Estates, Illinois, USA
Case History: A 26‐year‐old woman presented with a history of premature ovarian failure secondary to radiation and chemotherapy for the treatment of Hodgkin’s lymphoma at age 18. Her follicle stimulating hormone level was 85mIU/mL and anti‐Müllerian hormone level was <0.1 ng/mL. Ultrasound evaluation showed the ovaries to be small (1.5 mL in volume each) with no antral follicles. The uterus had a volume of 40 mL and thin endometrial lining at 4 mm. She was accepted to our donor oocyte program. Prior to the transfer cycle, she was treated sequentially with physiologic doses of estradiol (Estrace, 4 mg) orally and vaginal progesterone (Crinone gel, 8%) for 3 months. This resulted in a slight increase in the uterine volume (45 mL) and a peak endometrial thickness of 9 mm. There was a clinical pregnancy which unfortunately resulted in a spontaneous miscarriage at 8 weeks’ gestation.
Background
Over the last three decades advances in high dose chemotherapy and radiotherapy (RT) have resulted in an increase in the survival rates of most forms childhood cancers. In Europe, current estimates are that there are nearly 500,000 childhood cancer survivors with a median age between 25 and 29 years. Approximately 10,000 new survivors are added to these numbers on a yearly basis. The U.S. cancer statistics report of cancer incidence, mortality and survival from the American Cancer Society has also confirmed a sustained increase in the 5‐year relative survival rate of children and adolescents treated for all cancers combined [1]. Survival rates have thus undergone remarkable improvements from 58% during the mid‐1970s to 83% during 2007‐2013
