AMH may not predict oocyte yield in breast cancer patients
Levels of anti-Müllerian hormone (AMH) may not correlate with ovarian reserve in patients with breast cancer, suggests a study presented at ESHRE 2018, thus raising questions on the utility of AMH testing before hormonal stimulation in fertility preservation for women with breast cancer.
“The predictive value of AMH determination before hormonal stimulation in emergency fertility preservation for women in breast cancer is still debatable,” said lead author Dr Ida Wikander of Karolinska University Hospital in Stockholm, Sweden. “Measurements of serum AMH concentrations to evaluate ovarian reserve previously to fertility preservation might not correlate with the outcome in all patients with breast cancer.”
The prospective cohort study involved 124 women (mean age 32.8 years, majority were nulliparous) with breast cancer who underwent a hormonal stimulation cycle for fertility rescue, with or without letrozole supplement (dependent on tumour oestrogen receptor status) before starting chemotherapy. Hormonal stimulation was initiated on any day within their menstruation cycle, and serum AMH was sampled before starting stimulation. The mean AMH concentration was 2.32 µg/L (range 0.16–9.6), which lies within the normal range for age. [EHSRE 2018, abstract P-524]
AMH levels were only modestly correlated to oocyte yield, and the association was statistically nonsignificant.
Similarly, there was no significant correlation between AMH levels and age.
The researchers believed that one of the variables that could explain the findings was use of contraceptive pills, based on a subanalysis of 70 patients (56 percent of total population) who reported using contraceptive pills at the time of breast cancer diagnosis. Although women who previously used but had discontinued contraceptive pills at time of cancer diagnosis showed lower AMH levels than those who never used contraceptives, oocyte yield was similar between the two groups of women.
However, they also noted the variations in the time stimulation treatments among patients as a study limitation, as prolonged stimulation cycle was not possible in some cases due to planned chemotherapy initiation.
“A successful fertility rescue treatment can be crucial for the woman´s future possibility of [getting pregnant],” said Wikander.
Although previous studies have shown AMH to be predictive of ovarian reserve and oocyte yield after hormonal stimulation, the current findings suggest that this may not apply to patients with breast cancer before initiating chemotherapy, said Wikander, who suggested that “novel biomarkers should be investigated.”