Role of anti-Müllerian hormone in predicting premature ovarian insufficiency after pelvic radiotherapy.

BACKGROUND AND PURPOSE: Premature ovarian insufficiency (POI) frequently occurs in premenopausal women undergoing pelvic radiotherapy. Anti-Müllerian hormone (AMH) has emerged as a promising biomarker of ovarian reserve, but its role in evaluating post-radiotherapy ovarian function remains uncertain.

MATERIALS AND

METHODS

We retrospectively analyzed 23 premenopausal women (≤ 45 years) who received pelvic radiotherapy. POI was defined using two criteria: (1) persistently undetectable AMH (<0.0714 pmol/L) beyond 6 months post-radiotherapy or at last follow-up; and (2) sustained elevation of FSH (>30 mIU/mL) at the same timepoints. Logistic regression was used to identify clinical and dosimetric predictors for POI.

RESULTS

Based on AMH and FSH criteria, POI occurred in nine (39.1%) and eight (34.8%) patients, respectively, with 19 patients showing concordant classifications. AMH declined sharply after radiotherapy, and in some patients, recovered between 6 and 10 months, typically preceding FSH normalization. In AMH-based analysis, sequential brachytherapy following external beam radiotherapy was associated with a higher risk of POI (odds ratio [OR] 55.695, 95% confidence interval [CI] 1.456-2129.833, p = 0.031), and higher minimum radiation dose (Dmin) to the ovary was significantly associated with an increased risk of POI (OR 1.026, 95% CI 1.002-1.051, p = 0.037). For FSH-defined POI, higher ovarian Dmin was also an independent predictor (OR 1.046, 95% CI 1.008-1.086, p = 0.019), indicating a 4.6% increase in the odds of POI per 1 cGy increase in Dmin.

CONCLUSION

In premenopausal women undergoing pelvic radiotherapy, AMH levels declined earlier than FSH and may provide additional information for assessing ovarian reserve. Minimizing ovarian Dmin is important for preserving ovarian function.