title: Chemotherapy: Impact on Anti-Müllerian Hormone Levels in Breast Carcinoma.
abstract: BACKGROUND
  Anti-Mullerian Hormone (AMH) is a glycoprotein of the transforming growth factor-β (TGF-β) family that seems to reflect the continuous non-cyclical growth of small follicles and can be considered an indirect index of the size of the resting primordial follicle pool. Accordingly, AMH represents a marker of Ovarian Reserve (OR) and is particularly useful in demonstrating ovarian tissue damage induced by chemotherapy.
  
  
  OBJECTIVE
  To evaluate and compare the levels of AMH in Breast Carcinoma patients before and after chemotherapy with age matched healthy controls and to assess whether AMH as a biochemical marker of the OR might improve prediction of chemotherapy related outcomes in these patients.
  
  
  METHODS
  The present study was conducted in the Department of Biochemistry in collaboration with Department of Radiotherapy, Pt. B.D. Sharma, University of Health Sciences, Rohtak between June 2013 and June 2014. The subjects were divided into two groups. A total of 30 female patients of confirmed diagnosis of breast carcinoma were enrolled in the study group (Group I). The enrolled breast cancer cases were further divided into subgroups (Group-IA=Prechemotherapy & Group-IB= Postchemotherapy). Thirty healthy age matched female volunteers were enrolled as controls (Group II). Serum levels of AMH were determined by the ultrasensitive anti-müllerian hormone/ müllerian inhibiting substance (US AMH/MIS) Enzyme Linked Immuno Sorbent Assay (ELISA).
  
  
  RESULTS
  There was a significant decrease in serum AMH levels in the both study group-IA and study group-IB as compared to control group-II (p<0.05 and p<0.001 respectively). The prechemotherapy (group-IA) serum AMH levels dropped significantly after chemotherapy (group-IB) (p<0.001).
  
  
  CONCLUSIONS
  AMH levels declined after chemotherapy indicates direct chemotherapy induced damage to the granulosa cells and growing follicles, reflecting decrease ovarian reserve and fertility.
authors.affiliation: Senior Resident, Department of Biochemistry, PGIMS , Rohtak, Haryana, India .
authors.forename: Jyoti
authors.initials: J
authors.lastname: Bala
authors.affiliation: Senior Professor, Department of Biochemistry, PGIMS , Rohtak, Haryana, India .
authors.forename: Shashi
authors.initials: S
authors.lastname: Seth
authors.affiliation: Associate Professor, Department of Radiotherapy, PGIMS , Rohtak, Haryana, India .
authors.forename: Rakesh
authors.initials: R
authors.lastname: Dhankhar
authors.affiliation: Head and Senior Professor, Department of Biochemistry, PGIMS , Rohtak, Haryana, India .
authors.forename: Veena Singh
authors.initials: VS
authors.lastname: Ghalaut
keywords: FEC; Females; Fertility; Granulosa cells; Ovarian reserve