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Anti-Müllerian hormone screening to assess ovarian reserve among female survivors of childhood cancer

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Abstract

Purpose

Anti-Müllerian hormone (AMH) is an indicator of oocyte reserve in healthy females. The role of AMH testing in oncology remains investigational, although its sensitivity and stability over the menstrual cycle make it an attractive screening test for fertility assessment among female cancer survivors. We measured AMH level in survivors of childhood cancer and evaluated its association with treatment and patient factors.

Methods

Participants were adult female survivors of childhood malignancy treated with chemotherapy. Serum AMH was measured at a random day of the menstrual cycle. Multivariate analysis was used to evaluate the association between AMH level, alkylating agent exposure using the cyclophosphamide equivalent dose (CED), and other covariates.

Results

Sixty-six females with a median attained age of 23.3 years were eligible for analysis. Median AMH was 25.5 pM (range 0.5–108.0), at a median time of 11.5 years (range 1.4–25.1) since cancer diagnosis. Twenty-three patients (34.8 %) had low AMH, including a significant proportion that reported normal menstrual cycles. Compared to ALL survivors, sarcoma survivors had significantly lower AMH levels. Among alkylating agents evaluated, procarbazine had the greatest adverse effect on AMH. In multivariate analysis, higher CED (p = 0.001), older age at diagnosis (p < 0.001), and use of oral contraceptive pills (p = 0.04) remained significantly associated with lower AMH.

Conclusions

Random AMH can reveal evidence of oocyte depletion among female survivors reporting normal cycles, although low AMH should be interpreted cautiously among those taking oral contraception. Age at exposure and CED can aid identification of those more likely to have low AMH, although CED may underestimate the effect of procarbazine on oocyte reserve.

Implications for cancer survivors

Measurement of AMH can reveal apparent depletion of ovarian reserve in female childhood cancer survivors reporting normal menstrual cycles. Sarcoma survivors and those exposed to procarbazine may benefit from targeted AMH evaluation in an outpatient setting, and thereby allow appropriate fertility counseling before the onset of premature ovarian failure. The cyclophosphamide equivalent dose may facilitate comparison of the potential effect of different regimens on fertility.

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Acknowledgments

Dr. Charpentier is supported in part by the Princess Margaret Cancer Foundation—Department of Radiation Oncology Academic Enrichment Fund. Dr. Hodgson is supported by a Cancer Care Ontario Research Chair.

Conflict of interest

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Authors and Affiliations

  1. Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Anne-Marie Charpentier, Genevieve Gingras-Hill, Sameera Ahmed & David C. Hodgson

  2. Department of Radiation Oncology, Centre hospitalier de l’Université de Montréal, 1560 Sherbrooke Street East, Montreal, Quebec, H2L 4M1, Canada

    Anne-Marie Charpentier & Abha A. Gupta

  3. Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada

    Amy Lee Chong

  4. Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Candemir Cigsar

  5. Centre for Fertility and Reproductive Health, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada

    Ellen Greenblatt

  6. Department of Obstetrics and Gynecology, University of Toronto, 92 College Street, Toronto, Ontario, M5G 1L4, Canada

    Ellen Greenblatt

Authors
  1. Anne-Marie Charpentier
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  2. Amy Lee Chong
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  3. Genevieve Gingras-Hill
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  4. Sameera Ahmed
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  8. David C. Hodgson
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Correspondence to David C. Hodgson.

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Charpentier, AM., Chong, A.L., Gingras-Hill, G. et al. Anti-Müllerian hormone screening to assess ovarian reserve among female survivors of childhood cancer. J Cancer Surviv 8, 548–554 (2014). https://doi.org/10.1007/s11764-014-0364-4

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  • DOI: https://doi.org/10.1007/s11764-014-0364-4

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