title: Pretreatment serum anti-müllerian hormone predicts long-term ovarian function and bone mass after chemotherapy for early breast cancer.
abstract: BACKGROUND
  Administration of chemotherapy to premenopausal women shortens their reproductive lifespan by depleting nonrenewable oocytes. Preservation of fertility is a priority for many such women, and identification of women at risk of infertility is therefore important. However, age is the only patient characteristic currently recognized to be predictive of long-term ovarian function after chemotherapy.
  
  
  OBJECTIVE
  Our objective was to assess markers of ovarian reserve and age as long-term predictors of ovarian function after chemotherapy.
  
  
  METHODS
  We conducted a prospective, longitudinal study at a university hospital and research institute.
  
  
  METHODS
  Patients included women who were premenopausal at the time of diagnosis of early breast cancer.
  
  
  METHODS
  Ovarian function was assessed at 5 yr follow-up in relation to pretreatment hormonal and ultrasound markers of ovarian reserve.
  
  
  RESULTS
  Forty-two women received (neo-)adjuvant chemotherapy. Continuing menses 4-5 yr after diagnosis closely reflected ovarian activity as assessed by a range of serum markers, including estradiol, inhibin B, FSH, and anti-müllerian hormone (AMH). Pretreatment serum AMH, FSH, antral follicle count, and age predicted late ovarian activity by univariate analysis. However, only AMH was predictive in a multivariate logistic regression (odds ratio = 13.0; 95% confidence interval = 2.5-66.7); 0.71 ng/ml gave peak likelihood ratio of 7.0 with 54% sensitivity and 92% specificity. Bone mineral density fell over the 4-5 yr after diagnosis with greater loss in women with lower ovarian activity. Higher pretreatment AMH was associated with lower bone mineral density at both lumbar spine and hip at 5 yr (P < 0.02).
  
  
  CONCLUSIONS
  Measurement of AMH at cancer diagnosis predicts long-term ovarian function after chemotherapy. Use of this in clinical practice may allow better prediction of chemotherapy-related risk to future fertility.
authors.affiliation: Division of Reproduction and Developmental Sciences and Medical Research Council Human Reproductive Sciences Unit, Centre for Reproductive Biology, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom. richard.anderson@ed.ac.uk
authors.forename: Richard A
authors.initials: RA
authors.lastname: Anderson
authors.forename: David A
authors.initials: DA
authors.lastname: Cameron
mesh_terms: D000328:Adult; D000375:Aging / Q000502:physiology; D000568:Amenorrhea; D054304:Anti-Mullerian Hormone / Q000097:blood*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D001842:Bone and Bones / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005298:Fertility / Q000187:drug effects; D005640:Follicle Stimulating Hormone / Q000097:blood; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007246:Infertility / Q000453:epidemiology / Q000209:etiology; D016013:Likelihood Functions; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D010050:Ovarian Function Tests; D010053:Ovary / Q000502:physiology*; D011237:Predictive Value of Tests; D017697:Premenopause / Q000502:physiology; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D000970:Antineoplastic Agents; D012739:Gonadal Steroid Hormones; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone