Pretreatment Serum anti-müllerian Hormone Predicts Long-Term Ovarian Function and Bone Mass After Chemotherapy for Early Breast Cancer

J Clin Endocrinol Metab. 2011 May;96(5):1336-43. doi: 10.1210/jc.2010-2582. Epub 2011 Feb 16.

Abstract

Context: 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.

Design and setting: We conducted a prospective, longitudinal study at a university hospital and research institute.

Patients: Patients included women who were premenopausal at the time of diagnosis of early breast cancer.

Main outcome measures: 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).

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aging / physiology
  • Amenorrhea
  • Anti-Mullerian Hormone / blood*
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Bone Density / drug effects
  • Bone and Bones / anatomy & histology*
  • Breast Neoplasms / complications*
  • Breast Neoplasms / drug therapy
  • Female
  • Fertility / drug effects
  • Follicle Stimulating Hormone / blood
  • Gonadal Steroid Hormones / blood
  • Humans
  • Infertility / epidemiology
  • Infertility / etiology
  • Likelihood Functions
  • Logistic Models
  • Longitudinal Studies
  • Middle Aged
  • Ovarian Function Tests
  • Ovary / physiology*
  • Predictive Value of Tests
  • Premenopause / physiology
  • Prospective Studies
  • ROC Curve

Substances

  • Antineoplastic Agents
  • Gonadal Steroid Hormones
  • Anti-Mullerian Hormone
  • Follicle Stimulating Hormone