Effect of chemotherapy on the uterus of young adult cancer survivors

This pilot study aimed to accomplish 3 distinct but related goals. First, we described the structural phenotype of uterine/endometrial injury after alkylating chemotherapy sonographically and histologically. Second, we investigated the molecular impact of alkylating chemotherapy exposure on messenger RNA expression and epigenetic changes in endometrial biopsy (EMB) tissue homogenates. Third, we investigated the feasibility of performing ultrasonographic and EMB-based assessments in reproductive-age cancer survivors. Because of limited information available in this area of inquiry, this approach is exploratory and should prove to be hypothesis-generating. The main outcome measures of this study included endometrial thickness (EMT) and uterine volume on transvaginal ultrasound. Endometrial histology, DNA methylation, and RNA-seq on EMB samples, and pain scale assessment before and after EMB. The inclusion criteria were age of 18–45 years and consent for endometrial biopsy. The exclusion criteria were the absence of the uterus, completed pelvic radiation, uterine or cervical cancer, and metastatic cancer. Each participant underwent endometrial biopsy and pelvic ultrasound. All study visits were conducted in the late proliferative phase of the menstrual cycle.