Tamoxifen coadministration during controlled ovarian hyperstimulation for in vitro fertilization in breast cancer patients increases the safety of fertility preservation treatment strategies

Capsule:
In nonmenopausal breast cancer patients, tamoxifen effectively reduces cancer risk despite chronically extremely high E2 levels. Tamoxifen co-administration during conventional COH for IVF is effective without increasing risks to patients.

Authors:
Dror Meirow, M.D., Hila Raanani, M.D., Ettie Maman, M.D., Shani Paluch-Shimon, M.D., Moran Shapira, Bs.C., Yoram Cohen, M.D., Irena Kuchuk, M.D., Ariel Hourovitz, M.D., Jacob Levron, M.D., Michal Mozer Mendel, M.D., Masha Brenguaz, Ph.D., Hanna Biderman, M.D., Dafna Manela, M.D., Rephael Catane, M.D., Jehoshua Dor, M.D., Raol Orvieto, M.D., Bella Kaufman, M.D.

Volume 102, Issue 2, Pages 483–487

Abstract:

Objective:
To evaluate the utility of a hypersensitive assay for measuring low antimüllerian hormone (AMH) levels in young cancer patients during the ovarian recovery phase of their chemotherapy.

Design:
Retrospective study.

Setting:
Academic medical center.

Patient(s):
Fifty-eight samples drawn at least 3 months after the end of chemotherapy in 30 women having either breast cancer (n = 13) or hematologic malignancies (n = 17) were selected to constitute two equally size groups: amenorrhea (n = 30 samples) or spontaneous cycle (n = 28 samples).

Intervention(s):
None.

Main Outcome Measure(s):
Serum AMH levels were measured by a conventional AMH ELISA (EIA AMH/MIS) and a hypersensitive ELISA (PicoAMH, AnshLabs) on the same sample.

Result(s):
Using a conventional assay, serum AMH was detectable (≥3 pmol/L) in 6.7% and in 10.7% of the samples corresponding to amenorrheic or cycling patients, respectively (nonsignificant). By contrast, with PicoAMH, serum AMH was detectable (≥0.07 pmol/L) in 71.4% of the samples from cycling women vs. 16.7% of the samples from amenorrheic patients. Multivariate regression analysis showed that among putative contributors, only the menstrual status (r = 0.307) and serum FSH level (r = −0.546) were independently correlated to a detectable serum AMH with the picoAMH assay exclusively.

Conclusion(s):
The picoAMH assay, allowing measurement of very low AMH concentrations in human serum, should refine postchemotherapy ovarian follow-up in young women.

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