The role of combined anti-mullerian hormone and antral follicle count assessment in predicting cycle outcomes in cancer patients undergoing controlled ovarian stimulation for fertility preservation

Abstract

Chemotherapy is known to damage ovarian reserve and cause ovarian failure. Baseline hormone levels such as FSH and E2 are not reliable for predicting the effect of chemotherapy on fertility. The purpose of this study was to investigate whether the combined utility of AMH and antral follicle count (AFC) on CD2 is predictive for controlled ovarian hyperstimulation outcomes in pre- (COH) and post-chemotherapy (PCCOH) patients. Prospective. Women with cancer (69 COH and 16 PCCOH), of mostly breast origin (74/85, 87%), underwent ovarian stimulation with letrozole and gonadotropins or gonadotropins only. AMH and AFC were obtained on CD2. PCCOH patients received various gonadotoxic agents [AC (n = 4), ACT (n = 4), AT (n = 1), TC (n = 1), CHOP and TC (n = 1), FAC+T (n = 1), >4 agents (n = 1), unknown (n = 3)]. The mean age at time of stimulation (33.9 ± 0.6 vs. 34.0 ± 1.1 years), CD2-FSH (10.2 ± 0.6 vs. 10.0 ± 1.5 mlU/ml), and E2 (56.9 ± 5.2 vs. 60.7 ± 18.1 pg/ml) were similar between COH and PCCOH. The number of total (14.4 ± 1.3 vs. 8.0 ± 1.1) and mature (9.7 ± 0.8 vs. 5.9 ± 0.9) oocytes retrieved and 2PN embryos (7.7 ± 0.7 vs. 5.1 ± 0.8) were significantly higher for COH vs. PCCOH (P<0.05). Likewise, AMH (2.6 ± 0.4 vs. 1.1 ± 0.5 ng/ml) and AFC (13.1 ± 1.3 vs. 8.7 ± 1.2) were significantly higher in the COH vs. PCCOH (P<0.05). Linear regression analysis demonstrated a significant positive correlation for AMH as well as AFC in predicting the number of total oocytes, mature oocytes, and 2PN embryos in COH but not PCCOH patients (P<0.05). Multivariate regression analysis using both AMH and AFC enriched outcome prediction (R2 = 0.53). Chemotherapy adversely affects ovarian stimulation outcomes as well as AFC and AMH levels. Combined AFC and AMH assessment yields a strong correlation for predicting stimulation outcomes before chemotherapy but not afterwards. When feasible, evaluation of AMH and AFC prior to chemotherapy may improve prediction of patient outcome and aid clinical decision making.