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Anti-Müllerian hormone and fertility in women after childhood cancer treatment : Association with current infertility risk classifications

Nyström, Anna LU ; Mörse, Helena LU ; Øra, Ingrid LU orcid ; Henic, Emir LU ; Engellau, Jacob LU ; Wieslander, Elinore LU ; Tomaszewicz, Andrzej and Elfving, Maria LU (2024) In PLoS ONE 19(8). p.1-18
Abstract

Background To identify childhood cancer survivors (CCSs) at risk of premature ovarian insufficiency (POI) and impaired fertility is important given its impact on quality of life. The aim of this study was to assess ovarian markers and fertility outcomes in adult female CCSs. We used the Swedish and the PanCareLIFE classifications for infertility risk grouping. Methods 167 CCSs, at median age 34.6 years (19.3–57.8) with a median follow-up time of 25.4 years (11.6–41.3), and 164 healthy matched controls were included in this cross-sectional study. We assessed anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), ovarian volume (OV), and fertility outcomes. Based on gonadotoxic treatments given, CCSs were categorized into... (More)

Background To identify childhood cancer survivors (CCSs) at risk of premature ovarian insufficiency (POI) and impaired fertility is important given its impact on quality of life. The aim of this study was to assess ovarian markers and fertility outcomes in adult female CCSs. We used the Swedish and the PanCareLIFE classifications for infertility risk grouping. Methods 167 CCSs, at median age 34.6 years (19.3–57.8) with a median follow-up time of 25.4 years (11.6–41.3), and 164 healthy matched controls were included in this cross-sectional study. We assessed anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), ovarian volume (OV), and fertility outcomes. Based on gonadotoxic treatments given, CCSs were categorized into infertility risk groups. Results The median levels of AMH, AFC and OV were lower in CCSs (1.9 vs. 2.1 ng/ml, 12.0 vs. 13.0, 6.8 vs. 8.0 cm3) compared with controls, although statistically significant only for OV (p = 0.021). AMH levels in CCSs <40 years were lower for those classified as high-risk (p = 0.034) and very high-risk (p<0.001) for infertility, based on the Swedish risk classification. Similarly, AFC was reduced in the high-risk (p<0.001) and the very high-risk groups (p = 0.003). CCSs of all ages showed a trend towards impaired fertility, especially in the very high-risk group. POI was diagnosed in 22/167 CCSs, of whom 14 were in the high- and very high-risk groups. The results according to the PanCareLIFE classification were similar. Conclusion Both the Swedish and the PanCareLIFE infertility risk classifications are reliable tools for identifying those at risk of reduced ovarian markers and fertility, as well as POI. We recommend fertility preservation counselling for patients receiving highly gonadotoxic treatments (i.e., Cyclophosphamide Equivalent Dose ≥6 g/m2, radiotherapy exposure to ovaries or stem cell transplantation) with follow-up at a young reproductive age due to the risk of a shortened reproductive window.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
19
issue
8
article number
e0308827
pages
1 - 18
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:39133666
  • scopus:85201116264
ISSN
1932-6203
DOI
10.1371/journal.pone.0308827
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 Nyström et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
id
f93b81c0-bb7e-43f7-8036-7c0f93e4de46
date added to LUP
2024-08-30 05:42:57
date last changed
2025-06-07 08:30:44
@article{f93b81c0-bb7e-43f7-8036-7c0f93e4de46,
  abstract     = {{<p>Background To identify childhood cancer survivors (CCSs) at risk of premature ovarian insufficiency (POI) and impaired fertility is important given its impact on quality of life. The aim of this study was to assess ovarian markers and fertility outcomes in adult female CCSs. We used the Swedish and the PanCareLIFE classifications for infertility risk grouping. Methods 167 CCSs, at median age 34.6 years (19.3–57.8) with a median follow-up time of 25.4 years (11.6–41.3), and 164 healthy matched controls were included in this cross-sectional study. We assessed anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), ovarian volume (OV), and fertility outcomes. Based on gonadotoxic treatments given, CCSs were categorized into infertility risk groups. Results The median levels of AMH, AFC and OV were lower in CCSs (1.9 vs. 2.1 ng/ml, 12.0 vs. 13.0, 6.8 vs. 8.0 cm<sup>3</sup>) compared with controls, although statistically significant only for OV (p = 0.021). AMH levels in CCSs &lt;40 years were lower for those classified as high-risk (p = 0.034) and very high-risk (p&lt;0.001) for infertility, based on the Swedish risk classification. Similarly, AFC was reduced in the high-risk (p&lt;0.001) and the very high-risk groups (p = 0.003). CCSs of all ages showed a trend towards impaired fertility, especially in the very high-risk group. POI was diagnosed in 22/167 CCSs, of whom 14 were in the high- and very high-risk groups. The results according to the PanCareLIFE classification were similar. Conclusion Both the Swedish and the PanCareLIFE infertility risk classifications are reliable tools for identifying those at risk of reduced ovarian markers and fertility, as well as POI. We recommend fertility preservation counselling for patients receiving highly gonadotoxic treatments (i.e., Cyclophosphamide Equivalent Dose ≥6 g/m<sup>2</sup>, radiotherapy exposure to ovaries or stem cell transplantation) with follow-up at a young reproductive age due to the risk of a shortened reproductive window.</p>}},
  author       = {{Nyström, Anna and Mörse, Helena and Øra, Ingrid and Henic, Emir and Engellau, Jacob and Wieslander, Elinore and Tomaszewicz, Andrzej and Elfving, Maria}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{1--18}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Anti-Müllerian hormone and fertility in women after childhood cancer treatment : Association with current infertility risk classifications}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0308827}},
  doi          = {{10.1371/journal.pone.0308827}},
  volume       = {{19}},
  year         = {{2024}},
}