[O-292] PRE-TREATMENT ANTI-MULLERIAN HORMONE (AMH) LEVEL DETERMINES RATE OF POST-THERAPY OVARIAN RESERVE RECOVERY: ACUTE CHANGES IN OVARIAN RESERVE DURING AND AFTER CHEMOTHERAPY.
K. E. Dillon, M. D. Sammel, J. P. Ginsberg, J. E. Mersereau, Y. Gosiengfiao, C. R. Gracia. Obstetrics and Gynecology, University of Pennslyvania School of Medicine, Philadelphia, PA; Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA; Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; Pediatrics, Children's Memorial Hospital, Chicago, IL.
OBJECTIVE: Future fertility is an important concern to many cancer survivors. This study sought to identify factors associated with ovarian reserve (OR) impairment both during and immediately after cancer therapy.
DESIGN: Prospective cohort study.
MATERIALS AND METHODS: Adolescent and young adult females with a new diagnosis of cancer requiring chemotherapy were followed to assess measures of OR (serum follicle-stimulating hormone, lutenizing hormone, estradiol, inhibin B, anti-mullerian hormone (AMH), and ultrasound antral follicle count and mean ovarian volume) at 3 month intervals. Changes in OR were quantified for both the acute impact of chemotherapy using linear regression and the longitudinal recovery after therapy using mixed effects models adjusted for baseline ovarian reserve, use of alkylating agent, and hormone use.
RESULTS: 46 women with at least 1 pretreatment and 2 post-treatment study visits were included (mean follow-up 12 months). All measures of OR demonstrated significant changes during cancer therapy. Alkylating agent exposure and baseline OR were associated with the magnitude of impairment acutely, and pretreatment AMH levels were associated with the rate of recovery of AMH after treatment. In adjusted models, participants with a pre-treatment AMH level >2 ng/mL recovered at a rate of 11.9% per month after chemotherapy, whereas participants with pre-treatment AMH levels ≤2 ng/mL recovered at a rate of 2.6% per month after therapy cessation (p=0.003).
CONCLUSION: Young women undergoing cancer therapy experience acute changes in measures of OR, the magnitude of which are affected by baseline OR and alkylating agent exposure. These measures recover slowly in the months after treatment is complete and the rate of recovery of AMH is impacted by pretreatment levels. Fertility preservation counseling for young women with low baseline AMH levels should include strong consideration of embryo or oocyte banking.
Supported by: K01 L:1-CA-133839-03 & 1R01HD062797 (CG), and the Doris Duke Foundation (KED).
Wednesday, October 24, 2012 12:45 PM
Oral Session: Reproductive Endocrinology: Clinical