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Investigation of anti-Müllerian hormone concentrations in relation to natural conception rate and time to pregnancy

Published:February 09, 2018DOI:https://doi.org/10.1016/j.rbmo.2018.01.013

      Abstract

      The objectives of this study were to investigate whether anti-Müllerian hormone (AMH) concentrations can predict pregnancy rates and time to pregnancy (TTP) in women attempting to conceive naturally/having an unplanned conception, and whether there is a lower AMH threshold compatible with natural conception. This prospective cohort study included 260 women aged 25–42 years in two subcohorts: (A) healthcare workers at Rigshospitalet (2008–2010), and (B) women consulting the Fertility Assessment and Counselling Clinic (2011–2014), Rigshospitalet, Denmark. Pregnancy rates and TTP at 2-year follow-up were stratified into AMH groups: low: < 9.5 pmol/l, intermediate: 9.5–33 pmol/l, high: > 33 pmol/l. Pregnancy rates increased with increasing AMH: 60.1% (low) versus 70.0% (intermediate) versus 78.3% (high) (P = 0.03). The highest pregnancy rate (84.1%) was seen in regular cycling women with high AMH. TTP was reduced in women with high AMH compared with intermediate or low AMH (stepwise trend test P = 0.01). Natural conceptions were observed with AMH concentrations down to 1.2 pmol/l. In conclusion, high AMH, especially in ovulatory women, was associated with higher pregnancy rates. Nonetheless, TTP reflected a large variation in fecundity within similar AMH concentrations and natural conceptions occurred with AMH down to 1.2 pmol/l.

      Keywords

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      References

        • Anckaert E.
        • Oktem M.
        • Thies A.
        • Cohen-Bacrie M.
        • Daan N.M.
        • Schiettecatte J.
        • Muller C.
        • Topcu D.
        • Groning A.
        • Ternaux F.
        • Engel C.
        • Engelmann S.
        • Milczynski C.
        Multicentre analytical performance evaluation of a fully automated anti-Mullerian hormone assay and reference interval determination.
        Clin. Biochem. 2016; 49: 260-267
        • Bentzen J.G.
        • Forman J.L.
        • Pinborg A.
        • Lidegaard O.
        • Larsen E.C.
        • Friis-Hansen L.
        • Johannsen T.H.
        • Nyboe Andersen A.
        Ovarian reserve parameters: a comparison between users and non-users of hormonal contraception.
        Reprod. Biomed. Online. 2012; 25: 612-619
        • Bentzen J.G.
        • Forman J.L.
        • Johannsen T.H.
        • Pinborg A.
        • Larsen E.C.
        • Andersen A.N.
        Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive ageing.
        J. Clin. Endocrinol. Metab. 2013; 98: 1602-1611
        • Birch Petersen K.
        • Hvidman H.W.
        • Forman J.L.
        • Pinborg A.
        • Larsen E.C.
        • Macklon K.T.
        • Sylvest R.
        • Andersen A.N.
        Ovarian reserve assessment in users of oral contraception seeking fertility advice on their reproductive lifespan.
        Hum. Reprod. 2015; 30: 2364-2375
        • Birch Petersen K.
        • Maltesen T.
        • Forman J.L.
        • Sylvest R.
        • Pinborg A.
        • Larsen E.C.
        • Macklon K.T.
        • Nielsen H.S.
        • Hvidman H.W.
        • Nyboe Andersen A.
        The Fertility Assessment and Counselling Clinic–Does the concept work? A prospective two year follow up study of 519 women.
        Acta Obstet. Gynecol. Scand. 2016; 96: 313-325
        • Bunting L.
        • Boivin J.
        Development and preliminary validation of the fertility status awareness tool: FertiSTAT.
        Hum. Reprod. 2010; 25: 1722-1733
        • Daelemans C.
        • Smits G.
        • de Maertelaer V.
        • Costagliola S.
        • Englert Y.
        • Vassart G.
        • Delbaere A.
        Prediction of severity of symptoms in iatrogenic ovarian hyperstimulation syndrome by follicle-stimulating hormone receptor Ser680Asn polymorphism.
        J. Clin. Endocrinol. Metab. 2004; 89: 6310-6315
        • Deeks E.D.
        Elecsys((R)) AMH Assay: a review in anti-mullerian hormone quantification and assessment of ovarian reserve.
        Mol. Diagn. Ther. 2015; 19: 245-249
        • Depmann M.
        • Broer S.L.
        • van der Schouw Y.T.
        • Tehrani F.R.
        • Eijkemans M.J.
        • Mol B.W.
        • Broekmans F.J.
        Can we predict age at natural menopause using ovarian reserve tests or mother's age at menopause? A systematic literature review.
        Menopause. 2016; 23: 224-232
        • Depmann M.
        • Eijkemans M.J.
        • Broer S.L.
        • Scheffer G.J.
        • van Rooij I.A.
        • Laven J.S.
        • Broekmans F.J.
        Does anti-Mullerian hormone predict menopause in the general population? Results of a prospective ongoing cohort study.
        Hum. Reprod. 2016; 31: 1579-1587
        • Depmann M.
        • Broer S.L.
        • Eijkemans M.J.C.
        • van Rooij I.A.J.
        • Scheffer G.J.
        • Heimensem J.
        • Mol B.W.
        • Broekmans F.J.M.
        Anti-Mullerian hormone does not predict time to pregnancy: results of a prospective cohort study.
        Gynecol. Endocrinol. 2017; 10: 1-5
        • Dolleman M.
        • Verschuren W.M.
        • Eijkemans M.J.
        • Dolle M.E.
        • Jansen E.H.
        • Broekmans F.J.
        • van der Schouw Y.T.
        Reproductive and lifestyle determinants of anti-Mullerian hormone in a large population-based study.
        J. Clin. Endocrinol. Metab. 2013; 98: 2106-2115
        • Fraisse T.
        • Ibecheole V.
        • Streuli I.
        • Bischof P.
        • de Ziegler D.
        Undetectable serum anti-Mullerian hormone levels and occurrence of ongoing pregnancy.
        Fertil. Steril. 2008; 89: 723.e711-723.e729
        • Gassner D.
        • Jung R.
        First fully automated immunoassay for anti-Mullerian hormone.
        Clin. Chem. Lab. Med. 2014; 52: 1143-1152
        • Gohari M.R.
        • Ramezani Tehrani F.
        • Chenouri S.
        • Solaymani-Dodaran M.
        • Azizi F.
        Individualized predictions of time to menopause using multiple measurements of antimullerian hormone.
        Menopause. 2016; 23: 839-845
        • Hagen C.P.
        • Vestergaard S.
        • Juul A.
        • Skakkebaek N.E.
        • Andersson A.M.
        • Main K.M.
        • Hjollund N.H.
        • Ernst E.
        • Bonde J.P.
        • Anderson R.A.
        • Jensen T.K.
        Low concentration of circulating antimullerian hormone is not predictive of reduced fecundity in young healthy women: a prospective cohort study.
        Fertil. Steril. 2012; 98 (e1602): 1602-1608
        • Hvidman H.W.
        • Petersen K.B.
        • Larsen E.C.
        • Macklon K.T.
        • Pinborg A.
        • Nyboe Andersen A.
        Individual fertility assessment and pro-fertility counselling; should this be offered to women and men of reproductive age?.
        Hum. Reprod. 2015; 30: 9-15
        • Iliodromiti S.
        • Kelsey T.W.
        • Wu O.
        • Anderson R.A.
        • Nelson S.M.
        The predictive accuracy of anti-Mullerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature.
        Hum. Reprod. Update. 2014; 20: 560-570
        • Joffe M.
        • Key J.
        • Best N.
        • Keiding N.
        • Scheike T.
        • Jensen T.K.
        Studying time to pregnancy by use of a retrospective design.
        Am. J. Epidemiol. 2005; 162: 115-124
        • Kelsey T.W.
        • Wright P.
        • Nelson S.M.
        • Anderson R.A.
        • Wallace W.H.
        A validated model of serum anti-mullerian hormone from conception to menopause.
        PLoS ONE. 2011; 6 (e22024)
        • La Marca A.
        • Sighinolfi G.
        • Radi D.
        • Argento C.
        • Baraldi E.
        • Artenisio A.C.
        • Stabile G.
        • Volpe A.
        Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART).
        Hum. Reprod. Update. 2010; 16: 113-130
        • La Marca A.
        • Papaleo E.
        • Grisendi V.
        • Argento C.
        • Giulini S.
        • Volpe A.
        Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle-stimulating hormone starting dose in in vitro fertilization cycles.
        BJOG. 2012; 119: 1171-1179
        • Leridon H.
        • Slama R.
        The impact of a decline in fecundity and of pregnancy postponement on final number of children and demand for assisted reproduction technology.
        Hum. Reprod. 2008; 23: 1312-1319
        • Nelson S.M.
        • Pastuszek E.
        • Kloss G.
        • Malinowska I.
        • Liss J.
        • Lukaszuk A.
        • Plociennik L.
        • Lukaszuk K.
        Two new automated, compared with two enzyme-linked immunosorbent, antimullerian hormone assays.
        Fertil. Steril. 2015; 104 (e1016): 1016-1021
        • Overbeek A.
        • Broekmans F.J.
        • Hehenkamp W.J.
        • Wijdeveld M.E.
        • van Disseldorp J.
        • van Dulmen-den Broeder E.
        • Lambalk C.B.
        Intra-cycle fluctuations of anti-Mullerian hormone in normal women with a regular cycle: a re-analysis.
        Reprod. Biomed. Online. 2012; 24: 664-669
        • Schmidt L.
        • Sobotka T.
        • Bentzen J.G.
        • Nyboe Andersen A.
        Demographic and medical consequences of the postponement of parenthood.
        Hum. Reprod. Update. 2012; 18: 29-43
        • Somigliana E.
        • Lattuada D.
        • Colciaghi B.
        • Filippi F.
        • La Vecchia I.
        • Tirelli A.
        • Baffero G.M.
        • Paffoni A.
        • Persico N.
        • Bolis G.
        • Fedele L.
        Serum anti-Mullerian hormone in subfertile women.
        Acta Obstet. Gynecol. Scand. 2015; 94: 1307-1312
        • Steiner A.Z.
        • Herring A.H.
        • Kesner J.S.
        • Meadows J.W.
        • Stanczyk F.Z.
        • Hoberman S.
        • Baird D.D.
        Antimullerian hormone as a predictor of natural fecundity in women aged 30–42 years.
        Obstet. Gynecol. 2011; 117: 798-804
        • Steiner A.Z.
        • Pritchard D.
        • Stanczyk F.Z.
        • Kesner J.S.
        • Meadows J.W.
        • Herring A.H.
        • Baird D.D.
        Association between biomarkers of ovarian reserve and infertility among older women of reproductive age.
        JAMA. 2017; 318: 1367-1376
        • Streuli I.
        • de Mouzon J.
        • Paccolat C.
        • Chapron C.
        • Petignat P.
        • Irion O.P.
        • de Ziegler D.
        AMH concentration is not related to effective time to pregnancy in women who conceive naturally.
        Reprod. Biomed. Online. 2014; 28: 216-224
        • Tal R.
        • Tal O.
        • Seifer B.J.
        • Seifer D.B.
        Antimullerian hormone as predictor of implantation and clinical pregnancy after assisted conception: a systematic review and meta-analysis.
        Fertil. Steril. 2015; 103 (e113): 119-130
        • Tremellen K.
        • Savulescu J.
        Ovarian reserve screening: a scientific and ethical analysis.
        Hum. Reprod. 2014; 29: 2606-2614
        • Weenen C.
        • Laven J.S.
        • Von Bergh A.R.
        • Cranfield M.
        • Groome N.P.
        • Visser J.A.
        • Kramer P.
        • Fauser B.C.
        • Themmen A.P.
        Anti-Mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment.
        Mol. Hum. Reprod. 2004; 10: 77-83
        • Zarek S.M.
        • Mitchell E.M.
        • Sjaarda L.A.
        • Mumford S.L.
        • Silver R.M.
        • Stanford J.B.
        • Galai N.
        • White M.V.
        • Schliep K.C.
        • DeCherney A.H.
        • Schisterman E.F.
        Is anti-Mullerian hormone associated with fecundity? Findings from the EAGeR trial.
        J. Clin. Endocrinol. Metab. 2015; 100: 4215-4221

      Biography

      Anne-Sofie Korsholm is a pregraduate research student affiliated to the Fertility Clinic at Rigshospitalet. Her primary research areas include female infertility and preconception counselling. She is currently completing the graduate course at the Medical School of the University of Copenhagen.
      Key message
      High AMH, especially in ovulatory women, was found to be associated with higher natural conception rates. Nonetheless, time to pregnancy reflected a large variation in fecundity within similar AMH concentrations and natural conceptions occurred with AMH down to 1.2 pmol/l.