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#Grand Rounds

Do AMH Levels Truly Predict Ovarian Reserve in Women Over 30?

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BACKGROUND AND PURPOSE:

  • Antimüllerian hormone (AMH) is used clinically during fertility treatments prior to ovarian stimulation
    • Low levels (<1 ng/mL) is a predictor of poor prognosis for live birth and can guide medical management
  • Biomarkers such as AMH are commercially available to help women, without history of infertility, to predict whether they are at risk for early (<45 years of age) or premature (<40 years) loss of ovarian function
  • Steiner et al. (JAMA, 2017) sought to determine whether such biomarkers (AMH/FSH/inhibin B) are associated with reproductive potential in noninfertile women of older reproductive age

METHODS:

  • Prospective time-to-pregnancy cohort study (2008-2016)
  • 981 women aged 30 to 44 years with no history of infertility who had been trying to conceive for 3 months or less
  • Primary outcomes
    • Cumulative probability of conception by 6 and 12 cycles
    • Relative fecundability (probability of conception during a menstrual cycle)
  • Conception was defined as a positive pregnancy test result
  • Results adjusted for age, body mass index, race, current smoking status, and recent hormonal contraceptive use

RESULTS:

  • 750 women were included
  • When comparing women with low AMH values (<0.7 ng/mL) to those with normal values, there was no difference in predicted probability of conceiving
    • 6 cycles: 65% vs 62%
    • 12 cycles: 84% vs 75%
  • When comparing women with high serum FSH values (>10 mIU/mL) to those with normal values, there was no difference in predicted probability of conceiving
    • 6 cycles: 63% vs 62%
    • 12 cycles: 82% vs 75%
  • When comparing women with high urinary FSH values (>11.5 mIU/mg creatinine) to those with normal values, there was no difference in predicted probability of conceiving
    • 6 cycles: 61% vs 62%
    • 12 cycles: 70% vs 76%
  • Inhibin B levels were not associated with the probability of conceiving

CONCLUSION:

  • The use of urinary/blood FSH or AMH tests as biomarkers in noninfertile women to predict natural fertility is not supported based on the evidence presented in this study

Learn More – Primary Sources:

Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age

JAMA editorial: Using Antimüllerian Hormone to Predict Fertility

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Related ObG Topics:

Infertility Treatment and Childhood Development
Infertility Evaluation: Who, When and How
Can Anti-Müllerian Hormone Levels Predict Menopause?

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