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

Related ObG Topics:

Infertility Treatment and Childhood Development

Infertility Evaluation: Who, When and How

Can Anti-Müllerian Hormone Levels Predict Menopause?