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Anti-Muellerian hormone (AMH) as only possible marker in the assessment of ovarian function and reserve after hematopoietic stem cell transplantation (HSCT) in prepubertal girls, young females with composed hypogonadism and females receiving hormonal replacement therapy

Bone Marrow Transplantation volume 52, pages 313–316 (2017)Cite this article

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Gonadal dysfunction is the most frequent endocrine complication in long-term female survivors of hematopoietic stem cell transplantation (HSCT).1 It had been thought that young age protected from ovarian damage during HSCT.2 The analysis performed in children after HSCT in ALL has shown that in about 80% of these children there is an impairment of gonadal function.3 In girls the visible pubertal development may be adequate, but menstruation is only achieved in half of the individuals.4 The question of what is the ovarian reserve in girls and young women after HSCT is left unanswered. The classical tests used in the evaluation of the ovarian reserve have some inconveniences, especially in young patients after HSCT. Serum levels of follicle-stimulating hormone (FSH), Inhibin-B and estradiol (E2) are interdependent and should be performed in the early follicular phase. Nevertheless, the changes of serum levels of FSH, Inhibin-B and estradiol occur relatively late. It is not until age 7 years that elevated basal gonadotropins point to gonadal damage.5 Moreover in young patients with low gonadotropins level, we cannot exclude the central or the composed etiology of hypogonadism. Assessment of the number of antral follicles by ultrasonography best predicts the quantitative aspect of ovarian reserve,6 but using an transvaginal ultrasound during in the early follicular phase is often impossible in young females. Anti-Muellerian hormone (AMH) is a relatively new marker of the ovarian function and the ovarian reserve. This is the serum marker that reflects the number of follicles that have made the transition from the primordial pool into the growing follicle pool, and that is not controlled by gonadotropins.7 AMH is the earliest marker of diminishing ovarian reserve, with relatively minimal intra- and intercycle variation, and its serum levels decrease well before any increase in baseline FSH.8 There is a transient rise in AMH in the neonatal period due to a transient activation of the reproductive axis at that time, followed by a more sustained rise through childhood and adolescence. Some studies reported that there is a plateau or even a decline in AMH during puberty.9 AMH continues to rise after adolescence, with peak concentration, at approximately, the age of 24, and then decrease gradually with age, and the levels become undetectable after menopause.10 AMH expression is affected relatively little by use of the oral or vaginal administration of synthetic sex steroids.11 Additionally being not controlled by gonadotropins, AMH would benefit both patients and clinicians.

The aim of the study was to assess ovarian reserve in young patients after HSCT using evaluation of AMH hormone with comparison to classical hormonal tests.

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Acknowledgements

This study was supported by the Medical College, Jagiellonian University in Cracow Research Council (grant number K/ZDS/005688).

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  1. Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Medical College, Jagiellonian University in Krakow, Cracow, Poland

    A Wędrychowicz, J Wojtyś & J Starzyk

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  1. A Wędrychowicz
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Correspondence to A Wędrychowicz.

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Wędrychowicz, A., Wojtyś, J. & Starzyk, J. Anti-Muellerian hormone (AMH) as only possible marker in the assessment of ovarian function and reserve after hematopoietic stem cell transplantation (HSCT) in prepubertal girls, young females with composed hypogonadism and females receiving hormonal replacement therapy. Bone Marrow Transplant 52, 313–316 (2017). https://doi.org/10.1038/bmt.2016.273

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