Recovery of ovarian function after chemotherapy in premenopausal women with breast cancer: a systematic review and meta-analysis.

PURPOSE: To evaluate the probability, timing, and predictors of ovarian function recovery after chemotherapy in premenopausal women with breast cancer. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.