Current Practices in the Use of Anti-Mullerian Hormone for Surveillance of Ovarian Function in Childhood Cancer Survivors: A Report from the Pediatric and Adolescent Committee of the Oncofertility Consortium

Abstract

Purpose: Anti-Mullerian hormone (AMH) is a surrogate measure to assess ovarian reserve in childhood cancer survivors, but consensus is lacking on when to obtain and how to use AMH data. Methods: Pediatric and adolescent committee (PAC) members of the Oncofertility Consortium were invited by email to complete a survey regarding ovarian reserve surveillance and their use of AMH. Responses were collected through REDCap, and results were stratified by specialty: pediatric oncology and endocrinology (PED) or adult/pediatric gynecology and reproductive endocrinology (GYN). Descriptive statistics and Fisher's exact tests were used for analysis using SAS v9.4. Results: Surveys were completed by 48 of 123 eligible PAC members (28 PED, 19 GYN, response rate 39%). The majority (83.3%) reported using AMH as a measure of ovarian reserve, with the earliest timepoint to begin AMH surveillance to be 12-23 months from therapy completion (63%). While most respondents felt the benefits of testing outweighed the limitations (78.7%), commonly reported limitations included variability of results (60.4%) and lack of standardization in use of AMH (52.1%). Differences between PED and GYN respondents included how AMH was used among their clinical practice and the timing of laboratory evaluation. Conclusions: Most respondents indicated they used AMH; however, practices in its application varied depending on specialty backgrounds. Evidence-based clinical practice guidelines would improve the standardization of surveillance and counseling and prevent missed opportunities for fertility preservation in survivorship.

Keywords: AMH; ovarian reserve; surveillance; survivorship.