Abstract
Purpose of reviewIatrogenic ovarian damage can occur after chemotherapy, radiotherapy and surgery for cancer as well as for non-malignant conditions. This review describes the effects of such treatment on antimullerian hormone (AMH) and the implications of the fall in AMH in relation to ovarian function and fertility, especially in the era of improved fertility preservation strategies.Recent findingsThe risk of gonadotoxicity differs between chemotherapy regimens. There is growing evidence that pretreatment AMH has prognostic significance for the degree of fall in AMH after treatment, the reversibility of ovarian damage and risk of premature ovarian insufficiency. The accuracy of prediction increases when age is coupled with AMH. The adverse effect of removal of endometriomas is increasingly clear, and AMH pre and post surgery useful is assessing the degree of damage to the ovary. The implications of low AMH after such treatment on natural fertility and reproductive lifespan are less clear. Apart from treatment effects, there are other coexisting conditions that can affect AMH which needs to be taken into consideration during interpretation of AMH before and after treatment.SummaryA fall in AMH in women after gonadotoxic treatment has been consistently described, with variable recovery, the accurate interpretation and clinical application of post-treatment AMH level on reproductive lifespan and fertility prediction needs to be studied in future larger prospective studies with longer follow-up.
Highlights
Iatrogenic ovarian damage can occur with chemotherapy, radiotherapy and surgery for cancer, for non-malignant conditions such as conditioning for stem cell transplant in haematological diseases, and in gynaecological conditions such as endometriosis
It is important for clinicians to be able to detect and perhaps predict ovarian impairment early to optimize the management of these girls and women, allowing fertility preservation to be offered to those women who are at significant risk of permanent ovarian damage before they undergo gonadotoxic treatment such as total body irradiation (TBI) or high risk chemotherapy [1]
This review focuses on the use of antimullerian hormone (AMH)
Summary
Iatrogenic ovarian damage can occur with chemotherapy, radiotherapy and surgery for cancer, for non-malignant conditions such as conditioning for stem cell transplant in haematological diseases, and in gynaecological conditions such as endometriosis. Depending on age at treatment, impairment of ovarian function because of accelerated depletion of primordial follicles has implications for puberty, fertility and the long-term health consequences of oestrogen deficiency as it may result in a woman living more than half her life in a postmenopausal state. It is important for clinicians to be able to detect and perhaps predict ovarian impairment early to optimize the management of these girls and women, allowing fertility preservation to be offered to those women who are at significant risk of permanent ovarian damage before they undergo gonadotoxic treatment such as total body irradiation (TBI) or high risk chemotherapy [1].
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