Serum AMH level as a marker of acute and long-term effects of chemotherapy on the ovarian follicular content: a systematic review

Maëliss Peigné,Christine Decanter

doi:10.1186/1477-7827-12-26

Maëliss Peigné, Christine Decanter

Open Access

https://doi.org/10.1186/1477-7827-12-26

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Abstract

Anti-Müllerian hormone (AMH) is a very sensitive indicator of the ovarian follicular content. Chemotherapeutic agents are notoriously ovariotoxic in that they damage follicles. The aim of this systematic review was to investigate the interest of serum AMH variations in determining the acute and long-term effects of chemotherapy on the ovarian reserve. According to the PRISMA guidelines, searches were conducted on PubMed for all English language articles until December 2013. Fifteen articles that focused on dynamic variations of AMH levels before and after chemotherapy were selected. Cancer patients have significantly lower AMH after chemotherapy than age-matched controls. Longitudinal studies of AMH variations before, during and after chemotherapy provide information about the degree of follicle loss for each patient according to different chemotherapy regimens. Different patterns of AMH levels during the ovarian recovery phase make it possible to discriminate between high and low gonadotoxic chemotherapy protocols. In addition, pretreatment AMH levels are shown to predict the long-term ovarian function after the end of treatment. These results may help to better understand the ovarian toxicity mechanisms of chemotherapy and to predict the degree of the ovarian follicle loss. Therefore, it can be useful for fertility preservation strategies, fertility counseling and future family planning.

Highlights

With the continuous improvement of cure rate over the last few decades, ovarian function resurgence and reproductive capacity after cancer treatment have become important quality-of-life issues
This review aims to highlight whether serum Anti-Müllerian hormone (AMH) could be a valuable indicator of the acute and long-term effects of chemotherapy regimen on the ovarian follicular content and how it could help in better understanding the chemoinduced toxicity and in fertility preservation strategies
We examined the 36 published studies measuring AMH levels in women who have undergone chemotherapy for different types of cancer

Summary

Introduction

With the continuous improvement of cure rate over the last few decades, ovarian function resurgence and reproductive capacity after cancer treatment have become important quality-of-life issues Chemotherapy regimens, those including alkylating agents, are notoriously ovariotoxic by damaging all kinds of follicles from primary to preantral and antral stages [1,2,3,4]. Increased apoptotic processes seem to be the main factor [3,5,6,7,8,9], cortical fibrosis and blood vessel injury are described [10,11] It is well-established that the degree of this ovarian toxicity is highly dependent on age, treatment and dosage [5,12]. Ovarian damage can be permanent, in the case of protocols including alkylating agents, leading to premature ovarian failure

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