Date of Award

Spring 2018

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

McCarthy, Donna O.

Second Advisor

Garnier-Villarreal, Mauricio

Third Advisor

Ohlendorf, Jennifer M.


Reproductive dysfunction is reported as a major concern for childhood cancer survivors (CCS) and is highly correlated with quality of life in this population. Few predictors of post-treatment reproductive function in CCS have been identified. CCS report high levels of psychological stress. Psychological stress activates the hypothalamic-pituitary-adrenal axis, which can disrupt reproductive function. The purpose of this exploratory study was to explore the relationship between perceived stress, biomarkers of hypothalamic-pituitary-adrenal activity, gonadotropin levels, and anti-Müllerian hormone levels in female CCS. This exploratory cross-sectional study included female cancer survivors (ages 16-35) treated for pediatric cancer at the Royal Hospital for Sick Children in Edinburgh, Scotland. Perceived stress was measured using the Perceived Stress Scale (PSS-10). Hypothalamic-pituitary-adrenal activity (HPA) was measured using salivary and hair cortisol levels. Ovarian function was measured using serum gonadotropin levels and serum anti-Müllerian hormone levels. Latent growth curve modeling was used to determine diurnal cortisol slope and intercept. Bayesian structural equation modeling was used to explore the relationship between perceived stress, biomarkers of HPA activity and ovarian function. Twenty-four female (mean age 21.79 ± 5.68) CCS were included in the study. We found an inverse association between perceived stress and ovarian function and a positive association between biomarkers of HPA activity and ovarian function. The findings from this study suggest that perceived stress is negatively associated with ovarian function and that threshold cortisol levels are required for healthy ovarian function in female childhood cancer survivors.