Anti-Müllerian Hormone Is a Marker of Gonadotoxicity in Pre- and Postpubertal Girls Treated for Cancer: A Prospective Study

Context: Cytotoxic treatment may accelerate depletion of the primordial follicle pool, leading to impaired fertility and premature menopause. Assessment of ovarian damage in prepubertal girls is not currently possible, but Anti-Mullerian Hormone (AMH) is a useful marker of ovarian reserve in adults. Objective: The objective of the study was to prospectively evaluate AMH measurement in children as a marker of ovarian toxicity during cancer treatment. Design and Setting: This was a prospective, longitudinal study at a University Hospital. Patients: Twenty-two females (17 prepubertal), median age 4.4 yr (range 0.3–15 yr), were recruited before treatment for cancer. Main Outcome Measures: AMH, inhibin B, and FSH at diagnosis, after each chemotherapy course and during follow-up, were measured. Risk of gonadotoxicity was classified as low/medium (n = 13) or high (n = 9) based on chemotherapy agent, cumulative dose, and radiotherapy involving the ovaries. Results: Pretreatment AMH was detectable across the age r...