title: Anti-Müllerian hormone screening to assess ovarian reserve among female survivors of childhood cancer.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Charpentier
authors.forename: Amy Lee
authors.initials: AL
authors.lastname: Chong
authors.forename: Genevieve
authors.initials: G
authors.lastname: Gingras-Hill
authors.forename: Sameera
authors.initials: S
authors.lastname: Ahmed
authors.forename: Candemir
authors.initials: C
authors.lastname: Cigsar
authors.forename: Abha A
authors.initials: AA
authors.lastname: Gupta
authors.forename: Ellen
authors.initials: E
authors.lastname: Greenblatt
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
mesh_terms: D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D065851:Ovarian Reserve; D017741:Survivors; D055815:Young Adult
chemical_list: D054304:Anti-Mullerian Hormone