In part 1, we talked about ovarian reserve and chemotherapy,
how we make decisions for fertility preservation,
and how we approach fertility preservation in women with breast cancer.
In part 2, I'll be talking to you about how BRCA mutations affect ovarian reserve and reproduction.
An interesting observation we made while we were developing
the letrozole protocol and tamoxifen protocols in women with breast cancer,
was that those with BRCA mutations tended to have fewer oocytes on average.
If you had a BRCA1 mutation you would have a mean number of 7.4 oocytes,
compared to a BRCA mutation-negative person with 11.3.
Moreover, you can see on the bar graph that women with BRCA mutations
had something like 30 to 40 times higher risk of having a low response to ovarian stimulation
(especially the BRCA1 type), compared to those untested and negative.
In a more recent study, we confirmed these findings,
where we compared the ovarian stimulation response
between women who were BRCA-negative or untested, and those who had BRCA mutations.
This slide shows you the results from that study.
We found that women with BRCA mutations had
much fewer oocytes and much lower numbers of embryos.
Our studies also showed that women with BRCA1 mutations have lower ovarian reserve.
Serum AMH is the most sensitive marker of ovarian reserve.
In a study in 2013, a prospective study, we found that women,
especially with BRCA1 mutations, had lower serum AMH levels compared to those who were negative.
These findings were since confirmed by multiple studies,
as you see on this slide, around seven studies.