Abstract / Summary
To evaluate the probability, timing, and predictors of ovarian function recovery after chemotherapy in premenopausal women with breast cancer. The PubMed, Embase, Scopus, and Cochrane Library databases were searched systematically. Pooled odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated using random-effects models. Proportions were synthesized using restricted maximum likelihood with logit transformation. Subgroup analyses were conducted to explore factors associated with ovarian function recovery. PROSPERO registration: CRD420261343270. A total of 34 studies, including 10,216 premenopausal women, were analyzed. The probability of ovarian function recovery at 12, 24, and 60 months after chemotherapy was 30.4% (95% CI, 17.5-47.3), 38.5% (95% CI, 15.6-68.1), and 43.4% (95% CI, 9.4-84.9), respectively. The mean time to recovery was 12.3 months (95% CI, 8.7-15.9). Older age (OR, 0.25; 95% CI, 0.12-0.50) and longer chemotherapy duration (OR, 0.68; 95% CI, 0.50-0.92) were associated with a lower probability of ovarian function recovery. In individual studies, higher pretreatment anti-Müllerian hormone levels appeared to be associated with improved recovery, although pooled estimates were not statistically significant. The probability of ovarian function recovery after chemotherapy remains limited in premenopausal women; although recovery improves over time, overall rates remain modest. This represents an important treatment-related outcome that should be addressed during pretreatment counseling, through early discussions of reproductive risks, multidisciplinary fertility preservation counseling, and consideration of established fertility preservation methods before cancer-directed therapy.