Journal Article

Comparison of the multiples of the median of serum anti‐müllerian hormone and pregnancy outcomes in patients with gestational trophoblastic disease: A case–control study

Li, Raymond Hang Wun, Ngan, Hextan Yuen Sheung, Tse, Ka Yu, Lai, Theodora Hei Tung, Lau, Lesley Suk Kwan, Ngu, Siew Fei, Chu, Man Yee Mandy, Chan, Karen Kar Loen, Ng, Ernest Hung Yu

2024

Overview

Introduction Chemotherapy is crucial in treating gestational trophoblastic neoplasia (GTN), but its impact on gonadotoxicity is unclear. Materials and Methods This case–control study included 57 GTN patients and 19 age‐matched patients with molar pregnancies (MP) in 2012–2018. Multiples of the median (MoM) of the serum AMH levels were compared between the two groups, and between patients using single‐agent and combination chemotherapy, at baseline, 6, 12, and 24 months after treatment. Their pregnancy outcomes were also compared. Results There was no significant difference in the MoM of serum AMH between GTN and MP groups at all time points. Single‐agent chemotherapy did not adversely affect the MoM. However, those receiving combination chemotherapy had lower MoM than those receiving single‐agent chemotherapy at all time points. The trend of decline from the baseline was marginally significant in patients with combination chemotherapy, but the drop was only significant at 12 months (Z = −2.69, p = 0.007) but not at 24 months (Z = −1.90; p = 0.058). Multivariable analysis revealed that combination chemotherapy did not affect the MoM. There was no significant difference in the 4‐year pregnancy rate and the livebirth rate between the single‐agent and combination groups who attempting pregnancy, but it took 1 year longer to achieve the first pregnancy in the combination group compared to the single‐agent group (2.88 vs. 1.88 years). Conclusion This study showed combination chemotherapy led to a decreasing trend of MoM of serum AMH especially at 12 months after treatment, but the drop became static at 24 months. Although pregnancy is achievable, thorough counseling is still needed in this group especially those wish to achieve pregnancy 1–2 years after treatment or with other risk factors. Our study was also the first to use MoM of serum AMH to examine the effect of chemotherapy in GTD. We showed a trend of decrease in those receiving combination chemotherapy, but it became static between 12 and 24 months and the live birth rate was not jeopardized by the chemotherapy.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Age / Anti-Mullerian Hormone - therapeutic use / Anti‐müllerian hormone / Case-Control Studies / Chemotherapy / Female / Fertility / Gestational Trophoblastic Disease - drug therapy / gestational trophoblastic neoplasia / Hospitals / Humans / Hydatidiform Mole - drug therapy / molar pregnancy / ovarian reserve / Ovaries / Peptide Hormones / Pregnancy / Pregnancy Outcome / Retrospective Studies / Risk factors / Trophoblastic disease