Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

The Effects of Chemotherapy on the Levels of Serum Anti-Müllerian Hormone in Patients with Gestational Trophoblastic Neoplasia

Authors
1 Fatemieh Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran, Hamadan, Iran
2 Faculty of Rehabilitation, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran
3 Besat Hospital, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran
4 National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Background: Gestational trophoblastic neoplasia (GTN) is a group of tumors highly responsive to chemotherapy. It has been suggested that cancer therapies have detrimental effects on female fertility. Anti-Müllerian hormone (AMH) is considered fertility potential and ovarian reserves in women. The aim of this study was to compare serum AMH levels between the patients with GTN treated with chemotherapy and the patients with hydatidiform mole who underwent suction curettage without receiving any chemotherapy. Methods: In 35 patients with GTN, serum AMH levels were measured before suction curettage and after the administration of chemotherapy and compared with serum AMH levels measured in 35 patients with hydatidiform mole, who did not receive any chemotherapy as a control. In controls, serum levels of AMH were measured before suction curettage and at the time when beta human chorionic gonadotrophin (ß-hCG) levels approached zero concentration. Results: The mean serum AMH levels in the GTN group were significantly lower than those measured in the control group after chemotherapy. In addition, serum AMH levels measured after intervention in each group significantly decreased compared to the basal levels (p=0.034). Serum AMH levels showed significant differences between the patients who received chemotherapy regimens with methotrexate (MTX) alone, actinomycin-D (Act-D) alone, or the combination of MTX and Act-D (p=0.001). Conclusion: Our study showed that fertility preservation is of great importance in patients with GTN treated with chemotherapy. Furthermore, both MTX and Act-D could have potential adverse effects on ovarian reserve.
Keywords

  1. Rattanaburi A, Boonyapipat S, Supasinth Y. Human chorionic gonadotropin (hCG) regression curve for predicting response to EMA/CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine) regimen in gestational trophoblastic neoplasia. Asian Pac J Cancer Prev. 2015;16(12):5037-41.
  2. Goto H, Lindoso JAL. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther. 2010;8(4):419-33.
  3. Jordan S, Randall LM, Karamurzin Y, Ward P, Lin F, Brewster W, et al. Differentiating squamous cell carcinoma of the cervix and epithelioid trophoblastic tumor. Int J Gynecol Cancer. 2011;21(5):918-22.
  4. Abike F, Temizkan O, Payasli A, Avsar F, Karahan N, Baspinar S. Postmenopausal complete hydatidiform mole: a case report. Maturitas. 2008;59(1):95-8.
  5. Leenharattanarak P, Lertkhachonsuk R. Quality of life in gestational trophoblastic neoplasia patients after treatment in Thailand. Asian Pac J Cancer Prev. 2014;15(24):10871-4.
  6. Wang X, Yang J, Li J, Zhao J, Ren T, Feng F, et al. Fertility-sparing uterine lesion resection for young women with gestational trophoblastic neoplasias: single institution experience. Oncotarget. 2017;8(26):43368-75.
  7. Cameron KE, Kole MB, Sammel MD, Ginsberg JP, Gosiengfiao Y, Mersereau JE, et al. Acute menopausal symptoms in young cancer survivors immediately following chemotherapy. Oncology. 2018;94(4):200-6.
  8. Kondapalli LA, Dillon KE, Sammel MD, Ray A, Prewitt M, Ginsberg JP, et al. Quality of life in female cancer survivors: is it related to ovarian reserve? Qual Life Res. 2014;23(2):585-92.
  9. Dunlop CE, Anderson RA. Uses of anti-Müllerian hormone (AMH) measurement before and after cancer treatment in women. Maturitas. 2015;80(3):245-50.
  10. Gupta AA, Chong AL, Deveault C, Traubici J, Maloney AM, Knight S, et al. Anti-Müllerian hormone in female adolescent cancer patients before, during, and after completion of therapy: a pilot feasibility study. J Pediatr Adolesc Gynecol. 2016;29(6):599-603.
  11. Harzif AK, Wiweko B, Addina P, Iswaranti K, Silvia M, Mariana A, et al. Anti-Mullerian hormone levels in female cancer patients of reproductive age in Indonesia: A cross-sectional study. F1000Res. 2019;8:159.
  12. Bi X, Zhang J, Cao D, Sun H, Feng F, Wan X, et al. Anti-Müllerian hormone levels in patients with gestational trophoblastic neoplasia treated with different chemotherapy regimens: a prospective cohort study. Oncotarget. 2017;8(69):113920-7.
  13. Cavaliere A, Ermito S, Dinatale A, Pedata R. Management of molar pregnancy. J Prenat Med. 2009;3(1):15-7.
  14. Perveen S, Jabbar S, Nizar S. Gestational Trophoblastic Disease and Gestational Trophoblastic Neoplasm-An Experience at Tertiary Care Hospital. Ann Abbasi Shaheed Hosp Karachi KMDC. 2018;23(3):136-42.
  15. Spears N, Lopes F, Stefansdottir A, Rossi V, De Felici M, Anderson R, et al. Ovarian damage from chemotherapy and current approaches to its protection. Hum Reprod Update. 2019;25(6):673-93.
  16. Wenners A, Grambach J, Koss J, Maass N, Jonat W, Schmutzler A, et al. Reduced ovarian reserve in young early breast cancer patients: preliminary data from a prospective cohort trial. BMC Cancer. 2017;17(1):632.
  17. Gadducci A, Lanfredini N, Cosio S. Reproductive outcomes after hydatiform mole and gestational trophoblastic neoplasia. Gynecol Endocrinol. 2015;31(9):673-8.
  18. Fong SL, Lugtenburg P, Schipper I, Themmen A, De Jong F, Sonneveld P, et al. Anti-mullerian hormone as a marker of ovarian function in women after chemotherapy and radiotherapy for haematological malignancies. Hum Reprod. 2008;23(3):674-8.
  19. Decanter C, Morschhauser F, Pigny P, Lefebvre C, Gallo C, Dewailly D. Anti-Müllerian hormone follow-up in young women treated by chemotherapy for lymphoma: preliminary results. Reprod Biomed Online. 2010;20(2):280-5.
  20. Fréour T, Barrière P, Masson D. Anti-müllerian hormone levels and evolution in women of reproductive age with breast cancer treated with chemotherapy. Eur J Cancer. 2017;74:1-8.
  21. Iwase A, Sugita A, Hirokawa W, Goto M, Yamamoto E, Takikawa S, et al. Anti-Müllerian hormone as a marker of ovarian reserve following chemotherapy in patients with gestational trophoblastic neoplasia. Eur J Obstet Gynecol Reprod Biol. 2013;167(2):194-8.
  22. Camp-Sorrell D. Cancer and its treatment effect on young breast cancer survivors. Semin Oncol Nurs. 2009;25(4):251-8.
  23. Uyar I, Yucel OU, Gezer C, Gulhan I, Karis B, Hanhan HM, et al. Effect of single-dose methotrexate on ovarian reserve in women with ectopic pregnancy. Fertil Steril. 2013;100(5):1310-3.
  24. Olberding KE, Wang X, Zhu Y, Pan J, Rai SN, Li C. Actinomycin D synergistically enhances the efficacy of the BH3 mimetic ABT-737 by downregulating Mcl-1 expression. Cancer Biol Ther. 2010;10(9):918-29.
  25. Oriol B, Barrio A, Pacheco A, Serna J, Zuzuarregui JL, Garcia-Velasco JA. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve. Fertil Steril. 2008;90(5):1579-82.
  26. Blumenfeld Z, Avivi I, Eckman A, Epelbaum R, Rowe JM, Dann EJ. Gonadotropin-releasing hormone agonist decreases chemotherapy-induced gonadotoxicity and premature ovarian failure in young female patients with Hodgkin lymphoma. Fertil Steril. 2008;89(1):166-73.