title: A highly-sensitive anti-Müllerian hormone assay improves analysis of ovarian function following chemotherapy for early breast cancer.
abstract: OBJECTIVE
  Anti-Müllerian hormone (AMH) shows promise as a biomarker of the ovarian reserve but current assays are insufficiently sensitive to allow assessment of this post-chemotherapy in most women. We have assessed a new highly sensitive AMH assay (Ansh picoAMH) in the evaluation of ovarian activity in women with very low ovarian reserve after chemotherapy.
  
  
  METHODS
  A prospective cohort and an independent validation cohort of premenopausal women with early breast cancer (eBC) were recruited at the time of diagnosis (combined n=98), and ovarian reserve markers 2-5 years later following chemotherapy were assessed in relation to menstrual activity.
  
  
  RESULTS
  The picoAMH assay had a limit of detection of 7.5 pg/ml. AMH clearly distinguished women with ongoing menses from those with amenorrhoea at 2 years after diagnosis (mean 522 ± 169 versus 8.9 ± 1.3 pg/ml, P<0.0001) with high predictive value for continuing menses or amenorrhoea for the subsequent 3 years. AMH was detectable in more women than using a previous assay (P=0.004). Other markers of the ovarian reserve (follicle-stimulating hormone (FSH), inhibin B) were also of discriminatory value but to lesser extents. This finding was validated in a second, independent cohort of women treated for eBC.
  
  
  CONCLUSIONS
  The 10-fold increased assay sensitivity showed very clear distinction between groups based on ovarian activity with excellent prediction of future menses or amenorrhoea. This will improve assessment of post-chemotherapy ovarian function in women and may aid treatment decisions.
authors.affiliation: MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
authors.forename: Joyce
authors.initials: J
authors.lastname: Chai
authors.affiliation: MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
authors.forename: A Forbes
authors.initials: AF
authors.lastname: Howie
authors.affiliation: Edinburgh Breast Unit and Edinburgh University Cancer Research Centre, Western General Hospital, Edinburgh, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Cameron
authors.affiliation: MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK. Electronic address: richard.anderson@ed.ac.uk.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Anderson
mesh_terms: D054304:Anti-Mullerian Hormone / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010050:Ovarian Function Tests / Q000379:methods*; D010053:Ovary / Q000503:physiopathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D054304:Anti-Mullerian Hormone
keywords: AMH; Breast cancer; Chemotherapy; Ovarian function; Ovarian reserve