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