Background: Hypogonadism is one of the most frequent endocrine complication after hematopoietic stem cell transplantation (HSCT). In some patients hypogonadism could be transient, but very often coexists with prematury ovarian failure. Classical methods used in the diagnostics of hypogonadism have limitations for the prognosis of ovarian reserve.
Objective: The aim of the study was to assess ovarian reserve in patients after HSCT using evaluation of anti-Muellerian hormone (AMH) with comparison to classical hormonal methods.
Methods: Twenty-eight patients, median age 15.8 years, after allogeneic (19) and autologic (9) HSCT and 28 healthy age-matched controls were included in the study. Fasting blood samples for the measurement of FSH, LH, estrogens, PRL, SHBG, TSH, fT4, AMH, and Inhibin-B, if possibly in 35th day of the menstruation cycle, were taken. Hormones were measured by immunochemistry. Statistical analysis was performed using t-Student test.
Results: AMH and inhibin-B levels were significantly lower (P<0.001) and FSH and LH levels were significantly higher in patients after HSCT than in controls (P<0.01). In 20/28 patients AMH level was below 0.08 ng/ml as postmenopausal, only 2/28 have normal AMH values. Hypergonadotropic hypogonadism was observed in 21/28 patients, 7/28 patients have normal values of sex hormones (3/7 prepubertal). Patients with normal AMH, have normal other hormones and normal menstruation cycles (severe aplastic anemia). Six patients (Fanconi anemia 3, solid tumors 3) with AMH levels 0.081 ng/ml presented with prepubertal status with low FSH (3) spontaneous puberty (1) and normal menstruations (2). Their inhibin B level was within normal ranges.
Conclusion: Patients after HSCT have impaired ovarian reserve. The ovarian reserve is mostly related to the conditioning therapy before HSCT. AMH as well as Inhibin-B and FSH are specific and good markers for the assessment of ovarian function. AMH seems to be more sensitive test than other markers in the evaluation of ovarian reserve after HSCT.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology