Alison J Lunsford1, Kimberly Whelan2, Kenneth McCormick3, Janet F McLaren4. 1. Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama, Birmingham, Alabama. Electronic address: alison.lunsford@ttuhsc.edu. 2. Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama, Birmingham, Alabama. 3. Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama, Birmingham, Alabama. 4. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama.
Abstract
OBJECTIVE: To evaluate the utility of measuring antimüllerian hormone (AMH) in childhood cancer survivors to assess ovarian reserve, pubertal status, and fertility potential. DESIGN: Cross-sectional study. SETTING: Academic medical center. PATIENT(S): Fifty-three female childhood cancer survivors, median age 13.9 years (range: 9-25 years) recruited at least 1 year from completion of cancer therapy. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Serum AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol measurements, pubertal/menstrual history and Tanner staging, with risk of gonadotoxicity classified as low or high based on chemotherapy agent and pelvic/abdominal radiation. RESULT(S): Thirty-one of the 53 patients (58%) in the cohort had diminished ovarian reserve (DOR) detected by an AMH value <1 ng/mL. We detected DOR by a FSH value of >12 IU/mL in 17 patients (32%). The patients exposed to high-risk chemotherapy or pelvic radiation were at statistically significantly higher risk for DOR as measured by their AMH level. The AMH level was also statistically significantly lower in the patients who had delayed puberty. CONCLUSION(S): Using the serum gonadotropins level to screen childhood cancer survivors for ovarian failure is a suboptimal method. The AMH value identified the patients at risk for delayed puberty and those who could benefit from fertility preservation counseling, which makes AMH perhaps the optimal screening tool for assessing ovarian reserve in this population.
OBJECTIVE: To evaluate the utility of measuring antimüllerian hormone (AMH) in childhood cancer survivors to assess ovarian reserve, pubertal status, and fertility potential. DESIGN: Cross-sectional study. SETTING: Academic medical center. PATIENT(S): Fifty-three female childhood cancer survivors, median age 13.9 years (range: 9-25 years) recruited at least 1 year from completion of cancer therapy. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Serum AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol measurements, pubertal/menstrual history and Tanner staging, with risk of gonadotoxicity classified as low or high based on chemotherapy agent and pelvic/abdominal radiation. RESULT(S): Thirty-one of the 53 patients (58%) in the cohort had diminished ovarian reserve (DOR) detected by an AMH value <1 ng/mL. We detected DOR by a FSH value of >12 IU/mL in 17 patients (32%). The patients exposed to high-risk chemotherapy or pelvic radiation were at statistically significantly higher risk for DOR as measured by their AMH level. The AMH level was also statistically significantly lower in the patients who had delayed puberty. CONCLUSION(S): Using the serum gonadotropins level to screen childhood cancer survivors for ovarian failure is a suboptimal method. The AMH value identified the patients at risk for delayed puberty and those who could benefit from fertility preservation counseling, which makes AMH perhaps the optimal screening tool for assessing ovarian reserve in this population.
Authors: Sally A Dominick; Mamie R McLean; Brian W Whitcomb; Jessica R Gorman; Jennifer E Mersereau; Janet M Bouknight; H Irene Su Journal: Obstet Gynecol Date: 2015-09 Impact factor: 7.661
Authors: Ju Young Yoon; Hyeon Jin Park; Hee Young Ju; Jong Hyung Yoon; Jin Soo Chung; Sang Hyun Hwang; Dong Ock Lee; Hye Young Shim; Byung-Kiu Park Journal: Cancer Res Treat Date: 2017-01-25 Impact factor: 4.679
Authors: Helen Jopling; Allen Yates; Nicholas Burgoyne; Katharine Hayden; Christopher Chaloner; Lesley Tetlow Journal: Endocrinol Diabetes Metab Date: 2018-07-18