Improving Fertility Preservation Decisions in Cancer Patients: Insights from Hormonal Biomarkers

A recent study in Frontiers in Oncology reports associations between baseline anti-Mullerian hormone (AMH) and oocyte yield as well as subsequent pregnancy or live‑birth probability.

AMH reflects the size of the ovarian follicle pool and therefore provides a quantitative index of remaining ovarian reserve. Cohorts and registry analyses have used AMH to correlate baseline reserve with treatment response and oocyte yield. Studies also report associations between AMH and later pregnancy or live birth after fertility preservation, although follow‑up intervals, outcome ascertainment, and assay methods differ across series.

Given that heterogeneity, AMH is best used to convey likelihoods—not certainties—when counseling patients, and interpretation is most informative when combined with age and cancer‑specific factors.

Timely referral matters: most ovarian stimulation cycles can be started and completed in roughly 2–3 weeks when coordinated promptly, and random‑start stimulation protocols shorten scheduling barriers. Parallel oncology-fertility workflows and standardized rapid‑referral protocols allow egg or embryo retrieval without substantial delay to oncologic therapy in many cases, preserving both treatment timelines and patient options.

Other markers under investigation include follicle‑stimulating hormone (FSH), early‑cycle estradiol, inhibin B, and antral follicle count (AFC). AFC and AMH are the more direct measures of ovarian reserve; FSH and early‑cycle estradiol are cycle‑dependent and more variable, while inhibin B findings are inconsistent. In practice, AMH most consistently signals prognosis as a single marker, and selective use of multi‑marker panels plus AFC can add granularity for individualized counseling.

Prediction models retain important limits: precision and generalizability are reduced by heterogeneity in cancer type, age, prior ovarian surgery, chemotherapy regimen, and inconsistent AMH assays. Time pressure and psychological stress also complicate shared decision‑making.