AMH Levels in Pediatric Cancer Patients Before and After Treatment

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Frontiers in Medicine Published April 17, 2026 Medically reviewed April 25, 2026 Study authors: Sofia Nilsson, Ann Thurin-Kjellberg, Stina Järvholm, Cecilia Langenskiöld, Kirsten Mehlig, Marianne … DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Recognize AMH may reflect treatment-related ovarian reserve changes, but evidence is preliminary and observational.

This prospective cohort study with baseline data from a follow-up cohort assessed anti-mullerian hormone (AMH) as a surveillance modality for ovarian reserve in girls aged 0–17 years diagnosed with pediatric cancer. Participants were enrolled at the Pediatric Oncology Center at Sahlgrenska University Hospital in Gothenburg, Sweden, with planned follow-up every 2 years until patients are approximately 25 years old.

AMH was measured in 56 participants before cancer treatment started and in 18 after initiation of therapy. Overall AMH levels had a mean value of 1.7 μg/L, a median of 1.1 μg/L, and a range between 0.03 and 9.97 μg/L. Age-adjusted AMH values were 79% lower in patients who had already been exposed to cancer treatment compared with the untreated group.

Safety and tolerability were not reported, and no adverse events, serious adverse events, or discontinuations were described. The study did not report effect sizes, p-values, confidence intervals, or direction statistics for the primary outcome. Funding and conflicts of interest were not reported.

Limitations include the small sample size (74 participants), the imbalance between treated and untreated groups, and the baseline-only design of this report from a prospective follow-up study. Causality cannot be assessed from these observational data. The authors suggest AMH may enable identification of who would be likely to benefit from fertility preservation and when, but clinical application should remain cautious.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

Overall survival for childhood cancer continues to improve, and with a large proportion of patients reaching reproductive age the question of fertility is becoming increasingly important. The long-term side effects of cancer treatment can include reduced reproductive function. The aim of this study is to present the baseline data from inclusion of a prospective follow-up study of fertility surveillance in children diagnosed with cancer. We are striving to evaluate whether anti-mullerian hormone (AMH) could be used as a surveillance modality in prospective monitoring of ovarian reserve in female childhood cancer survivors. Participants aged 0–17 years were enrolled at the Pediatric Oncology Center at Sahlgrenska University Hospital in Gothenburg, Sweden, between May 2016 and March 2021. Inclusion criteria were new diagnosis of pediatric cancer and scheduled treatment with chemotherapy and/or radiotherapy. The cohort will be part of a longitudinal follow-up program until the patients are approximately 25 years old; at this age puberty has passed and ovarian reserve in adult age can be evaluated. AMH levels are measured at inclusion and then every 2 years. Fertility preservation treatment will be offered in appropriate cases. After initial assessment of data, 74 participants were included in the study. The mean age was 7.7 years (median 8). The most common type of cancer was solid tumors (n = 24), followed by leukemia (n = 21). The baseline data showed initial levels of AMH between 0.03 and 9.97 μg/L, with a mean value of 1.7 μg/L and a median value of 1.1 μg/L. Fifty-six participants had AMH measured before cancer treatment started, and 18 had AMH levels taken after initiation of cancer therapy. Age-adjusted AMH values were on average 79% lower in patients who had already been exposed to cancer treatment compared with the untreated group. Two patients were offered fertility preservation before initiation of cancer therapy. This is a presentation of the baseline data from a planned long-term follow-up study. The long-term study has a unique prospective design that will follow girls from cancer diagnosis through their adolescence and up to fertile age, including an assessment of AMH levels. This may enable identification of who would be likely to benefit from fertility preservation, and when.