Antimullerian hormone as a measure of reproductive function in female childhood cancer survivors

Capsule:
Antimullerian hormone may be the optimal screening tool for assessing ovarian reserve in childhood cancer survivors, allowing for timely initiation of pubertal induction and fertility counseling.

Authors:
Alison J. Lunsford, M.D., Kimberly Whelan, M.D., Kenneth McCormick, M.D., Janet F. Mclaren, M.D.

Volume 101, Issue 1, Pages 227-231, January 2014

Abstract:

Objective:
To evaluate the utility of measuring antimüllerian hormone (AMH) in childhood cancer survivors to assess ovarian reserve, pubertal status, and fertility potential.

Design:
Cross-sectional study.

Setting:
Academic medical center.

Patient(s):
Fifty-three female childhood cancer survivors, median age 13.9 years (range: 9–25 years) recruited at least 1 year from completion of cancer therapy.

Intervention(s):
None.

Main Outcome Measure(s):
Serum AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol measurements, pubertal/menstrual history and Tanner staging, with risk of gonadotoxicity classified as low or high based on chemotherapy agent and pelvic/abdominal radiation.

Result(s):
Thirty-one of the 53 patients (58%) in the cohort had diminished ovarian reserve (DOR) detected by an AMH value <1 ng/mL. We detected DOR by a FSH value of >12 IU/mL in 17 patients (32%). The patients exposed to high-risk chemotherapy or pelvic radiation were at statistically significantly higher risk for DOR as measured by their AMH level. The AMH level was also statistically significantly lower in the patients who had delayed puberty.

Conclusion(s):
Using the serum gonadotropins level to screen childhood cancer survivors for ovarian failure is a suboptimal method. The AMH value identified the patients at risk for delayed puberty and those who could benefit from fertility preservation counseling, which makes AMH perhaps the optimal screening tool for assessing ovarian reserve in this population.

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