Hum. Reprod. Advance Access originally published online on January 18, 2009
Human Reproduction 2009 24(4):982-990; doi:10.1093/humrep/den487
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Assessment of ovarian reserve in adult childhood cancer survivors using anti-Müllerian hormone
1 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands 2 Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children’s Hospital, PO Box 2040, 3000 CA Rotterdam, The Netherlands 3 Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
4 Correspondence address. Tel: +31 10 7033371; E-mail: s.liefong{at}erasmusmc.nl
BACKGROUND: The aim was to assess possible treatment-induced gonadal damage in a cohort of adult female childhood cancer survivors (CCS) using anti-Müllerian hormone (AMH), the most sensitive marker of ovarian reserve.
METHODS: A total cohort of 185 survivors was compared with 42 control subjects. The median follow-up time was 18.1 years (range 4.1–43.2 year).
RESULTS: Median AMH concentrations in the analysed cohort were not different from controls (median 1.7 versus 2.1 µg/l; P = 0.57). However, AMH levels were lower than the 10th percentile of normal values in 27% (49/182) of our survivors. In addition, 43% (79/182) had AMH levels lower than 1.4 µg/l, a previously established cut-off value which predicts ongoing pregnancy after assisted reproduction. There were no differences in AMH levels in subgroups classified according to disease. However, survivors treated with three or more procarbazine containing chemotherapy cycles had significantly lower AMH levels than controls (median 0.5 µg/l; P = 0.004). Also survivors treated with abdominal or total body irradiation had significantly lower AMH levels than controls (median < 0.1 µg/l; P < 0.001).
CONCLUSIONS: AMH can be used to identify subgroups of CCS at risk for decreased fertility or premature ovarian failure. In these survivors, options for fertility preservation should be considered prior to starting treatment since they may be at risk for poor chances of pregnancy after assisted reproductive treatment.
Key words: anti-Müllerian hormone/childhood cancer/cancer survivor/premature ovarian failure/ovarian reserve/pregnancy
Submitted on October 2, 2008; resubmitted on December 2, 2008; accepted on December 15, 2008.
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