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.

  • Javier Domingo del Pozo

    Congratulations for your interesting study. I agree with you and most of the postpubertal cancer survivors, mostly if they have low AMH values, should be recommended for oocyte cryopreservation, due to the high risk of POF and sterility in the future. Although low or very low response will be expected, they would benefit of the value and better prognosis of age. Although they can delay motherhood what would increase the risk of POF, oocyte cryopreservation must also be considered not only for the first child, but often for more children in the future if desired.

  • Lauren Johnson

    Congratulations to Dr. Lunsford and Dr. McLaren for this informative study. The authors show that AMH levels are significantly lower among female childhood cancer survivors with delayed puberty compared to survivors with normal pubertal progression. Interestingly, 90% of adolescents in this cohort who had delayed puberty also had an undetectable AMH.

    I am curious to know if the authors have incorporated AMH into the work-up for
    delayed puberty for childhood cancer survivors. If so, what AMH cut-off do you
    use as evidence to start estrogen therapy?

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