The role of antimullerian hormone in assessing ovarian damage from chemotherapy, radiotherapy and surgery

Abstract

Purpose of reviewIatrogenic ovarian damage can occur after chemotherapy, radiotherapy and surgery for cancer as well as for non-malignant conditions. This review describes the effects of such treatment on antimullerian hormone (AMH) and the implications of the fall in AMH in relation to ovarian function and fertility, especially in the era of improved fertility preservation strategies.Recent findingsThe risk of gonadotoxicity differs between chemotherapy regimens. There is growing evidence that pretreatment AMH has prognostic significance for the degree of fall in AMH after treatment, the reversibility of ovarian damage and risk of premature ovarian insufficiency. The accuracy of prediction increases when age is coupled with AMH. The adverse effect of removal of endometriomas is increasingly clear, and AMH pre and post surgery useful is assessing the degree of damage to the ovary. The implications of low AMH after such treatment on natural fertility and reproductive lifespan are less clear. Apart from treatment effects, there are other coexisting conditions that can affect AMH which needs to be taken into consideration during interpretation of AMH before and after treatment.SummaryA fall in AMH in women after gonadotoxic treatment has been consistently described, with variable recovery, the accurate interpretation and clinical application of post-treatment AMH level on reproductive lifespan and fertility prediction needs to be studied in future larger prospective studies with longer follow-up.

AMH as an ovarian function predictor in premenopausal female breast cancer patients receiving chemotherapy is effective only for those over 35 years old

“…Although studies have shown that AMH is of little value in predicting ovarian function in underage chemotherapy patients, no reasonable explanation has been found [20,21,28,30]. In our study on healthy women, the AMH level has a persistent trend of decline with ageing in women over 35 years old but remains relatively stable in women younger than 35 years old, which means AMH may not be an accurate and suitable biomarker of ovarian reserve for younger women [31,32]. We got a similar result in mice study, the AMH level decreased with ageing in mice after an increasing during the first 6 months.…”

“…However, in young adults, even if the growing follicles were largely killed by chemotherapy drugs, the remaining growing follicles and the timely replenishment of the primordial follicular pool could maintain the stability of AMH, so the serum AMH level could not accurately reflect the damage degree of ovarian function. On the contrary, AMH can accurately reflect the injury of ovarian function in middle-aged and elderly female due to the limited ovarian reserve [31,33].…”

AMH as an ovarian function predictor in premenopausal female breast cancer patients receiving chemotherapy is effective only for those over 35 years old

“…Although studies have shown that AMH is of little value in predicting ovarian function in underage chemotherapy patients, no reasonable explanation has been found [20,21,28,30]. In our study on healthy women, the AMH level has a persistent trend of decline with ageing in women over 35 years old but remains relatively stable in women younger than 35 years old, which means AMH may not be an accurate and suitable biomarker of ovarian reserve for younger women [31,32]. We got a similar result in mice study, the AMH level decreased with ageing in mice after an increasing during the first 6 months.…”

“…However, in young adults, even if the growing follicles were largely killed by chemotherapy drugs, the remaining growing follicles and the timely replenishment of the primordial follicular pool could maintain the stability of AMH, so the serum AMH level could not accurately reflect the damage degree of ovarian function. On the contrary, AMH can accurately reflect the injury of ovarian function in middle-aged and elderly female due to the limited ovarian reserve [31,33].…”

AMH as the primary marker for fertility

“…It is difficult to draw any conclusion on the predictive value of low AMH after ovarian cystectomy on fertility outcome as most studies do not include pregnancy as an outcome. Interpretation of results from studies reporting pregnancy needs to be cautious, as we need to know whether those women included in the studies sought to become pregnant, and the studies usually only report pregnancy as a secondary outcome (50).…”