Anti-Mullerian hormone levels decline under hormonal suppression: a prospective analysis in fertile women after delivery
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RESEARCH
Open Access
Anti-Mullerian hormone levels decline under hormonal suppression: a prospective analysis in fertile women after delivery Andrea Weghofer1,2*, Wolf Dietrich1,3, Iris Ortner4, Christian Bieglmayer5, David Barad2,6 and Norbert Gleicher2,7
Abstract Background: AMH’s reported stability during periods of hormonal change makes it a practical tool in assessing ovarian reserve. However, AMH declines with age and age-specific cut-offs remain to be established in women with proven fertility. This study aims to determine age-specific ranges of AMH in women with proven fertility. Methods: Two hundred-ten fertile women, aged 18-40 years, were prospectively recruited for AMH measurements within 14 days after delivery and age stratified into 3 groups (18-30, 31-36 and 37-40 years). Eligibility required spontaneous conception within a maximal period of six months. Autoimmune diseases, chemotherapy, radiation, ovarian surgery and polycystic ovary syndrome precluded inclusion. Results: 95% confidence intervals of AMH declined with advancing female age from 0.9-1.1 to 0.6-0.9 and 0.2-0.4 ng/mL (P < 0.001). AMH levels were not statistically associated with day of blood draw after delivery or pregnancy characteristics. Neither were they predictive of resumption of menses. They, however, at all ages were lower than reported in the literature for infertile patients. Conclusions: Like infertile populations, fertile women demonstrate declining AMH with advancing age. Uniformly lower levels than in infertile women suggest that AMH levels do not appear as stable under all hormonal influences as previously reported.
Background Accurate assessments of ovarian reserve are crucial and allow for appropriate counselling during women’s reproductive life spans. Anti-Müllerian hormone (AMH) is increasingly used as diagnostic marker in assessing ovarian reserve (OR). Indeed, we and others reported improved accuracy in predicting oocyte yields and pregnancy potential, compared to baseline follicle stimulating hormone (b-FSH) [1,2]. Anti-Müllerian hormone is produced in granulosa cells of small follicles from primary stage on [3,4]. By inhibiting follicular recruitment [3], AMH exerts regulative functions on folliculogenesis, and serum concentrations are relatively closely reflective of numbers of antral follicles [5,6]. Antral follicle counts are, however, widely believed to be directly proportional to a woman’s total follicle pool and, * Correspondence: [email protected] 1 Department of Obstetrics & Gynecology, Medical University Vienna, Austria Full list of author information is available at the end of the article
therefore, reflective of her OR [3,5,7]. AMH’s reported stability during periods of hormonal change, such as menstrual cycles and in association with pregnancy, supports the assumption that AMH may, indeed, be reflective of a woman’s total follicle pool [8-10]. This AMH characteristic also makes it a more practical clinical tool in comparison to other modalities [11]. AMH, however, gradually declines
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