Abstract

Chemotherapy and related cancer therapies can injure the ovary, accelerate follicular depletion, and increase the risk of Premature Ovarian Insufficiency (POI) and fertility impairment. Anti-Müllerian Hormone (AMH), secreted by granulosa cells of growing preantral and small antral follicles, closely tracks the functional ovarian reserve and is relatively stable across the menstrual cycle, making it a practical biomarker for serial monitoring during and after cancer treatment. Across malignancies, AMH commonly falls to very low or undetectable concentrations during chemotherapy, with partial and age- and regimen-dependent recovery thereafter. Robust prospective data in early breast cancer show that undetectable AMH measured 6 months after chemotherapy can diagnose persistent ovarian failure at ≈30 months with high accuracy (AUROC ~0.89), and that pretreatment AMH adds predictive value beyond age for long-term ovarian activity. More recent individual-patient-data meta-analyses and trial-linked biomarker studies have refined these observations, confirming the prognostic contribution of pretreatment AMH while underscoring persistent challenges, including assay heterogeneity and difficulty establishing universally applicable cutoffs for clinical decision-making. Clinically, AMH supports fertility counselling and survivorship care; it also informs endocrine therapy choices when interpreted alongside estradiol, FSH, age, and treatment details. However, AMH is not a direct “fertility test,” does not reflect oocyte quality, and pregnancies can occur despite low or even undetectable values. Standardization of assays is progressing but incomplete, and consensus on timing/frequency of testing is evolving-particularly in adolescents and young adult (AYA) survivors. This review synthesizes contemporary evidence on AMH trajectories by disease and regimen, diagnostic and prognostic performance before and after chemotherapy, guideline-anchored applications, practical implementation issues, and priority gaps for future research.

Keywords:Anti-Müllerian hormone; Chemotherapy; Ovarian reserve; Premature ovarian insufficiency; Breast cancer; Lymphoma; Fertility preservation; Ovarian protection; Survivorship