2022-RA-1478-ESGO Change of anti-mullerian hormone levels in patients with gestational trophoblastic neoplasia and molar pregnancy – a case-control study

Introduction/Background

Gestational trophoblastic neoplasia (GTN) occurs in among women of reproductive age. Chemotherapy can result in the loss of primordial follicles and reduced ovarian reserve. Using anti-Mullerian hormone (AMH) as a surrogate, we evaluated the impact of chemotherapy in patients who received chemotherapy for GTN.

Methodology

This was a retrospective case-control study. Women aged between 20 and 44 years old with GTN who had received chemotherapy, or with treated molar pregnancy were identified between 2012 and 2018. AMH levels were measured at pre-treatment, 6, 12, and 24 months. Demographic factors, clinical characteristics, and the AMH levels between the 2 groups were compared using Mann Whitney U test and the difference between different timepoints was analysed using Wilcoxon signed rank test or Friedmann's test.

Results

57 GTN patients and 18 age-matched controls with molar pregnancies aged 20–45 years old were identified. There was no difference in the demographic factors. No significant difference in AMH levels was observed between GTN and molar pregnancy group at all time points. However, among those receiving combination chemotherapy for GTN, post-hoc analysis showed a significant difference between pre- and 12 months post-treatment (Z=-2.29, P=0.02), pre- and 24 months post-treatment (Z= -2.29; P = 0.02). To adjust for the effect of age on AMH levels, all serum AMH levels were expressed as multiples of the median (MoM) against age-specific AMH reference ranges for Chinese women. Only the use of combination chemotherapy was correlated with the MoM.

Conclusion

Our results showed that single agent chemotherapy did not adversely affect the AMH level regardless of number of cycles. The only factor that might possibly lower the AMH level was the use of combination chemotherapy. This study would help provide better counselling to patients with GTN with regards to the effects of chemotherapy on subsequent ovarian reserve.