Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors

Beth Zhou, Brian Kwan, Milli J. Desai, Vinit Nalawade, Kathryn J. Ruddy, Paul C. Nathan, Henry J. Henk, James D. Murphy, Brian W. Whitcomb, H. Irene Su

Research output: Contribution to journalArticlepeer-review


Objective: To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data. Design: In a cross-sectional design, AMH levels in patients who developed incident breast cancer between ages 15–39 years during 2005–2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups. Setting: Commercially insured females in the United States. Patient(s): Females with and without breast cancer. Exposure(s): Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy. Main Outcome Measure(s): AMH levels. Result(s): A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0–6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2–4 years, and then by a plateau over 1–2 years before a decline was observed. Conclusion(s): In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan.

Original languageEnglish (US)
Pages (from-to)1047-1056
Number of pages10
JournalFertility and sterility
Issue number5
StatePublished - May 2022


  • AMH
  • breast cancer
  • cyclophosphamide
  • ovarian reserve
  • platinum

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology


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