Serum anti-Müllerian hormone levels: a novel measure of ovarian reserve

• Published in: Human reproduction (Oxford) Vol. 17; no. 12; pp. 3065 - 3071
• Main Authors: van Rooij, I.A.J., Broekmans, F.J.M., te Velde, E.R., Fauser, B.C.J.M., Bancsi, L.F.J.M.M., Jong, F.H.de, Themmen, A.P.N.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.12.2002; Oxford Publishing Limited (England)
• Subjects: Adult; Anti-Mullerian Hormone; Biological and medical sciences; Biomarkers - blood; Birth control; Cell Count; Female; Fertilization in Vitro; Follicle Stimulating Hormone - blood; Glycoproteins; Gonadotropin-Releasing Hormone - agonists; Growth Inhibitors - blood; Gynecology. Andrology. Obstetrics; Humans; Inhibins - blood; Luteinizing Hormone - blood; Medical sciences; Oocytes; Ovarian Follicle - diagnostic imaging; Ovary - physiology; Prospective Studies; Sterility. Assisted procreation; Testicular Hormones - blood; Ultrasonography; IVF; antral follicle count; poor response; anti-Müllerian hormone; ovarian reserve; In vitro fertilization embryo transfer; Human; Ovary; Antimüllerian hormone; Functional response; Female genital system; Assisted procreation; Biological marker; Stimulation; anti-Müllerian hormone/antral follicle count/IVF/ovarian reserve/poor response; Ovarian follicle; Quantitative analysis
• ISSN: 0268-1161; 1460-2350; 1460-2350
• DOI: 10.1093/humrep/17.12.3065

BACKGROUND: Anti-Müllerian hormone (AMH) is produced by the granulosa cells of preantral and small antral follicles and its levels can be assessed in serum. Since the number of ovarian follicles declines with increasing age, AMH levels might be used as a marker for ovarian ageing. Therefore, we studied the relationship between AMH levels and ovarian response during ovarian stimulation for IVF. METHODS: A total of 130 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospectively included. Blood withdrawal was performed and the number of antral follicles was assessed by ultrasound on day 3 of a spontaneous cycle. Poor response and the number of oocytes were used as primary outcome measures. In a random subset of 23 patients a GnRH agonist stimulation test was performed to investigate whether a rise in FSH and LH would affect AMH levels. RESULTS: The data of 119 patients were analysed. Serum AMH levels were highly correlated with the number of antral follicles (r = 0.77; P < 0.01) and the number of oocytes retrieved (r = 0.57, P < 0.01). A negative association was found between AMH levels and poor ovarian response (fewer than 4 oocytes or cycle cancellation; OR 0.82, 95% CI 0.75–0.90, P < 0.01). Inclusion of inhibin B and FSH concentrations to AMH in a multivariate model improved the prediction of ovarian response. The post GnRH agonist rise in FSH and LH levels did not influence AMH values. CONCLUSIONS: Poor response in IVF, indicative of a diminished ovarian reserve, is associated with reduced baseline serum AMH concentrations. In line with recent observations it appears that AMH can be used as a marker for ovarian ageing.