Longitudinal AMH trajectories, ovarian reserve recovery, and fertility outcomes after multiagent chemotherapy for high-risk gestational trophoblastic neoplasia: A real-world cohort study.

OBJECTIVE

To characterize anti-Müllerian hormone (AMH) recovery after multiagent chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) and evaluate the impact of regimen and hysterectomy.

METHODS

This was a retrospective cohort of 68 high-risk GTN patients treated with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine, n = 39) or FAEV (fluorouracil, actinomycin D, etoposide, and vincristine, n = 29). AMH was measured at baseline, during treatment, and 1 and 6 months after chemotherapy. Generalized estimating equation models assessed associations of regimen and hysterectomy (n = 18) with longitudinal AMH trajectories. Fertility outcomes were collected in uterus-preserving patients.

RESULTS

Median AMH was 2.73, 0.04, 0.47, and 1.26 ng/mL at baseline, during treatment, and 1- and 6-month post-chemotherapy, respectively. By 6 months, 73.5% (50/68) recovered to AMH ≥ 1.0 ng/mL. FAEV was associated with higher AMH during treatment and at 1 month versus EMA/CO (geometric mean ratios 2.19 and 2.55; both P < 0.05) and a higher 6-month recovery rate (86.2% vs. 74.4%). Hysterectomy was associated with higher AMH during treatment (geometric mean ratio 2.25; P = 0.018) but not with 6-month AMH. Among 28 uterus-preserving patients actively attempting pregnancy, 20 (71.4%) achieved ≥ 1 live birth; 6-month AMH was higher in those with live birth (median 1.95 vs. 1.08 ng/mL; exploratory P = 0.053).

CONCLUSION

Multiagent chemotherapy for high-risk GTN causes profound yet partially reversible ovarian reserve suppression, with recovery continuing through at least 6 months. FAEV may be less acutely gonadotoxic than EMA/CO, and hysterectomy does not appear to compromise longer-term AMH recovery. Six-month AMH may help guide fertility counseling and individualized follow-up.