AMH After Breast Cancer Chemotherapy: Can an Ultrasensitive Test Predict Ovarian Insufficiency?

A study of 145 premenopausal women examined very low AMH levels during and after treatment.

End-of-chemotherapy measurements predicted one-year ovarian insufficiency better than pretreatment measurements in this cohort.

An ultrasensitive AMH test may help assess premature ovarian insufficiency after breast cancer chemotherapy, according to a study of 145 premenopausal women. Measuring tiny amounts of hormone remaining at treatment completion provided information about ovarian function one year later.

Researchers from Shanghai Jiao Tong University and the University of Edinburgh reported the findings in the October 2026 issue of Human Reproduction.

The approach may improve follow-up, but an AMH result alone cannot determine whether ovarian function is permanently lost or predict an individual's eventual pregnancy outcome.

Why conventional AMH measurements can reach their limits

Chemotherapy can affect ovarian follicles as well as cancer cells. Periods may become irregular or stop, and some women develop premature ovarian insufficiency.

AMH is used as an indirect marker of ovarian reserve. After chemotherapy, however, concentrations often fall below the range measurable by conventional assays.

An undetectable result does not necessarily mean complete loss of ovarian function; it may reflect the test's detection limit.

The researchers used an assay approximately 100 times more sensitive than conventional testing to distinguish very low concentrations.

Following 145 women before and after treatment

The study included premenopausal women aged 18–46 with breast cancer: 83 scheduled for chemotherapy and 62 comparison participants who did not receive chemotherapy.

Blood samples were collected before treatment, during treatment, at completion, and at three, six and twelve months afterward.

The ultrasensitive assay could detect AMH at approximately 0.13 pg/mL. It quantified AMH in every blood sample analyzed, including concentrations difficult to measure with conventional methods.

The researchers examined not only the decline in AMH but also whether end-of-treatment concentrations were associated with later ovarian function.

Approximately 30% had ovarian insufficiency at one year

At twelve months after chemotherapy, approximately 30% of women met the study's criteria for premature ovarian insufficiency.

This involves substantially impaired ovarian function earlier than the usual age of menopause and can cause irregular or absent periods and affect fertility.

Differences were already apparent before treatment. Median pretreatment AMH was 5.425 ng/mL among women who did not develop ovarian insufficiency and 1.103 ng/mL among those who did.

At chemotherapy completion, the corresponding medians were 0.127 ng/mL and 0.010 ng/mL.

Both groups experienced substantial declines, but the small amount remaining differed according to later ovarian function. Measuring these low concentrations may therefore provide additional prognostic information.

Better discrimination at the end of chemotherapy

Using pretreatment AMH, sensitivity for identifying women who later developed ovarian insufficiency was 67%, while specificity for identifying those who did not was 95%.

At chemotherapy completion, sensitivity was 81% and specificity 93%. Overall predictive performance was better at the end of treatment.

Thus, initial AMH remained informative, but measuring the tiny residual concentration immediately afterward appeared more useful in this cohort.

Low AMH still does not establish permanent loss of ovarian function. Some recovery can occur, and the test does not directly measure natural-conception or live birth prospects.

Follow-up testing complements, rather than replaces, preservation counseling

Young women facing cancer treatment need timely discussion of egg or embryo freezing and other suitable preservation options before chemotherapy.

After treatment begins, predicting damage and recovery is difficult. If validated for clinical use, ultrasensitive testing could reduce uncertainty and support more detailed reproductive follow-up.

This was a single-center study without long-term pregnancy or live birth outcomes. Its results should not alone determine whether preservation is needed or settle future fertility expectations.

Measuring ovarian function after treatment and deciding whether to preserve reproductive material beforehand are separate decisions.

AMH primarily reflects the follicle pool rather than egg quality or the probability of pregnancy. Age, menstrual function, chemotherapy regimen and treatment intensity remain relevant.

The study supports tracking ovarian changes through and after treatment instead of relying solely on one pretreatment measurement. The assay is a possible tool for longer-term reproductive care, alongside cancer survival and quality of life.

Study source

Xiaojun Kuang, Dongmei Lai, Richard A. Anderson and colleagues from Shanghai Jiao Tong University School of Medicine and the University of Edinburgh: “Monitoring ovarian reserve dynamics via a high-sensitivity anti-Müllerian hormone assay in premenopausal breast cancer patients undergoing chemotherapy.” Human Reproduction, October 2026 issue. DOI: 10.1093/humrep/deag136. PMID: 42664366.

The illustration was generated using ChatGPT (OpenAI). Any people depicted are fictional.