Role of anti-Müllerian hormone in predicting premature ovarian insufficiency after pelvic radiotherapy.

Background and purpose: Premature ovarian insufficiency (POI) frequently occurs in premenopausal women undergoing pelvic radiotherapy. Anti-Müllerian hormone (AMH) has emerged as a promising biomarker of ovarian reserve, but its role in evaluating post-radiotherapy ovarian function remains uncertain. Materials and methods: We retrospectively analyzed 23 premenopausal women (≤ 45 years) who received pelvic radiotherapy. POI was defined using two criteria: (1) persistently undetectable AMH (<0.0714 pmol/L) beyond 6 months post-radiotherapy or at last follow-up; and (2) sustained elevation of FSH (>30 mIU/mL) at the same timepoints. Logistic regression was used to identify clinical and dosimetric predictors for POI. Results: Based on AMH and FSH criteria, POI occurred in nine (39.1%) and eight (34.8%) patients, respectively, with 19 patients showing concordant classifications. AMH declined sharply after radiotherapy, and in some patients, recovered between 6 and 10 months, typically preceding FSH normalization. In AMH-based analysis, sequential brachytherapy following external beam radiotherapy was associated with a higher risk of POI (odds ratio [OR] 55.695, 95% confidence interval [CI] 1.456-2129.833, Conclusion: In premenopausal women undergoing pelvic radiotherapy, AMH levels declined earlier than FSH and may provide additional information for assessing ovarian reserve. Minimizing ovarian Dmin is important for preserving ovarian function.