IntroductionChemotherapy is crucial in treating gestational trophoblastic neoplasia (GTN), but its impact on gonadotoxicity is unclear.Materials and MethodsThis case–control study included 57 GTN patients and 19 age‐matched patients with molar pregnancies (MP) in 2012–2018. Multiples of the median (MoM) of the serum AMH levels were compared between the two groups, and between patients using single‐agent and combination chemotherapy, at baseline, 6, 12, and 24 months after treatment. Their pregnancy outcomes were also compared.ResultsThere was no significant difference in the MoM of serum AMH between GTN and MP groups at all time points. Single‐agent chemotherapy did not adversely affect the MoM. However, those receiving combination chemotherapy had lower MoM than those receiving single‐agent chemotherapy at all time points. The trend of decline from the baseline was marginally significant in patients with combination chemotherapy, but the drop was only significant at 12 months (Z = −2.69, p = 0.007) but not at 24 months (Z = −1.90; p = 0.058). Multivariable analysis revealed that combination chemotherapy did not affect the MoM. There was no significant difference in the 4‐year pregnancy rate and the livebirth rate between the single‐agent and combination groups who attempting pregnancy, but it took 1 year longer to achieve the first pregnancy in the combination group compared to the single‐agent group (2.88 vs. 1.88 years).ConclusionThis study showed combination chemotherapy led to a decreasing trend of MoM of serum AMH especially at 12 months after treatment, but the drop became static at 24 months. Although pregnancy is achievable, thorough counseling is still needed in this group especially those wish to achieve pregnancy 1–2 years after treatment or with other risk factors.

中文翻译：

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妊娠滋养细胞疾病患者血清抗苗勒管激素中位数倍数与妊娠结局的比较：病例对照研究

简介化疗对于治疗妊娠滋养细胞肿瘤（GTN）至关重要，但其对性腺毒性的影响尚不清楚。材料和方法这项病例对照研究包括 2012-2018 年 57 名 GTN 患者和 19 名年龄匹配的葡萄胎妊娠（MP）患者。比较两组之间以及使用单药和联合化疗的患者在基线、治疗后 6、12 和 24 个月时的血清 AMH 水平中位数 (MoM) 的倍数。比较两组妊娠结局。结果GTN组和MP组各时间点血清AMH MoM均无显着性差异。单药化疗不会对 MoM 产生不利影响。然而，在所有时间点，接受联合化疗的患者的 MoM 均低于接受单药化疗的患者。在接受联合化疗的患者中，相对于基线的下降趋势略有显着，但下降仅在 12 个月时才显着（Z=−2.69，p= 0.007) 但不是在 24 个月时 (Z=−1.90；p= 0.058）。多变量分析显示联合化疗不影响MoM。尝试怀孕的单药组和联合用药组的4年妊娠率和活产率没有显着差异，但联合用药组首次妊娠的时间比单药组多了1年(2.88 vs. 1.88年)。结论本研究显示联合化疗导致血清AMH MoM呈下降趋势，尤其是在治疗后12个月，但下降在24个月时趋于稳定。虽然怀孕是可以实现的，但该群体仍需要彻底的咨询，尤其是那些希望在治疗后 1-2 年内怀孕或存在其他危险因素的人。