Pretreatment antimüllerian hormone levels determine rate of posttherapy ovarian reserve recovery: acute changes in ovarian reserve during and after chemotherapy.
OBJECTIVE
To identify factors associated with ovarian reserve impairment during and immediately after chemotherapy.


METHODS
Prospective cohort study.


METHODS
Four university hospitals.


METHODS
Forty-six adolescent and young adult women with a new diagnosis of cancer requiring chemotherapy.


METHODS
None.


METHODS
Measurements of ovarian reserve via levels of serum follicle-stimulating hormone, luteinizing hormone, estradiol, inhibin B, and antimüllerian hormone (AMH) as well as antral follicle counts and mean ovarian volume at 3-month intervals.


RESULTS
Changes in ovarian reserve were quantified for both the acute impact of treatment using linear regression and the longitudinal recovery after therapy using mixed-effects models adjusted for baseline ovarian reserve, use of alkylating agent, and hormone use. The women had at least one pretreatment and two posttreatment study visits (mean follow-up interval: 12 months). All measures of ovarian reserve demonstrated statistically significant changes during chemotherapy. Alkylating agent exposure and baseline ovarian reserve were acutely associated with the magnitude of impairment, and pretreatment AMH levels were associated with the rate of recovery of AMH after treatment. In adjusted models, participants with a pretreatment AMH level > 2 ng/mL recovered at a rate of 11.9% per month after chemotherapy, whereas participants with pretreatment AMH levels ≤ 2 ng/mL recovered at a rate of 2.6% per month after therapy.


CONCLUSIONS
Baseline ovarian reserve and alkylating agent exposure effect the magnitude of acute changes in ovarian reserve from chemotherapy. The rate of recovery of AMH is impacted by pretreatment levels. This should be considered during pretreatment fertility preservation counseling.
Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Katherine E
KE
Dillon
Mary D
MD
Sammel
Maureen
M
Prewitt
Jill P
JP
Ginsberg
Dana
D
Walker
Jennifer E
JE
Mersereau
Yasmin
Y
Gosiengfiao
Clarisa R
CR
Gracia
D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000139:chemically induced*; D016649:Primary Ovarian Insufficiency / Q000097:blood* / Q000139:chemically induced* / Q000503:physiopathology; D020127:Recovery of Function; D055815:Young Adult
D000970:Antineoplastic Agents; D054304:Anti-Mullerian Hormone