• Ramesh Omranipour, Fatemeh Ahmadi-Harchegani, Azin Saberi, Ashraf Moini, Mostafa Shiri, Amirmohsen Jalaeefar, Arvin Arian, Akram Seifollahi, Mahshad Madani, Bita Eslami, and Sadaf Alipour.
• Breast Diseases Research Center (BDRC), Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
• Arch Iran Med. 2024 Feb 1; 27 (2): 9610496-104.

BackgroundBreast cancer (BC) treatment decreases fertility capacity, but unnecessary fertility preservation procedures in women who would not be infertile after treatment would be a waste of time and resources and could cause the unwarranted exposure of cancer cells to exogenous sex hormones. It has been largely shown that post-treatment ovarian reserve is directly associated with pre-treatment anti-mullerian hormone levels (AMH0). A threshold for AMH0, or a model including AMH0 and patient characteristics that could distinguish the patients who will be infertile after treatments, still needs to be defined. Accordingly, this study was performed to specifically target this high-priority concern.MethodsWomen≤45 years old with newly diagnosed non-metastatic BC were entered in this multicenter prospective cohort study. AMH0 and two-year post-treatment AMH (AMH2) were measured, and hormonal patient features were recorded as well. Receiver operating characteristic (ROC) curve analysis, decision tree (DT), and random forest analyses were performed to find a cut-off point for AMH0 and define a model involving related features for the prediction of AMH2.ResultsThe data from 84 patients were analyzed. ROC curve analysis revealed that AMH0>3 ng/mL (Area under the curve=0.69, 95% CI: 0.54‒0.84) was the best indicator for predicting AMH2≥0.7 (sensitivity=79%, specificity=60%). The best model detected by DT and random forest for predicting an AMH2>0.7 with a probability of 93% consisted of a combination of AMH0>3.3, menarche age<14, and age<31.ConclusionThis combination model can be used to withhold fertility preservation procedures in BC patients. Performing larger studies is suggested to further test this model.© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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