Ethnic discordance in serum anti-Müllerian hormone in healthy women: a population study from China and Europe

Published:November 28, 2019DOI:


      • Chinese women have higher AMH concentrations than European women before age 25.
      • From age 25 Chinese women have lower AMH concentrations than European women.
      • The disparity between the two populations widens with increasing age.


      Research question

      Chinese women are known to have an earlier age of natural menopause than their European counterparts, but whether they also have a lower functional ovarian reserve is unknown. This study was designed to assess whether there are ethnic differences in anti-Müllerian hormone (AMH) concentrations in women of reproductive age.


      Women in China and Europe with regular menstrual cycles, not on hormonal contraception and with no medical history of note, were recruited to provide a day 2–5 early follicular phase sample. AMH concentration was determined using the Roche Elecsys assay. Decline in AMH was modelled with linear, quadratic and quadratic with interaction on age equations to assess the impact of ethnicity.


      A total of 887 European and 461 Chinese women participated in the study. Despite the Chinese population being slightly younger (34.1 ± 8.4 years) than their European counterparts (34.8±8.9 years), their median AMH was lower, at 1.87 ng/ml (interquartile range [IQR] 0.28–3.64) compared with 2.11 ng/ml (IQR 0.73–3.96), with evidence of increasing discordance from age 25 years. In all regression models of the age-related decline in AMH, there was evidence of a difference between Chinese and European women. Although AMH was 28.1% (95% confidence interval [CI] 18.2–36.7%) lower in the Chinese population at age 30, this decline increased to 79.4% (95% CI 75.4– 82.9%) at age 45.


      There were independent effects of age and ethnicity on serum AMH concentrations, with Chinese women having a substantially lower AMH in adult life than their European counterparts from age 25 onwards.


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      Scott Nelson is the Muirhead Chair in Obstetrics and Gynaecology at the University of Glasgow, UK. He undertook his medical training in Glasgow, with a PhD from the University of Dundee, UK. Professor Nelson's particular area of expertise is in the use of biomarkers to individualize care.
      Key message
      We observed ethnic differences in the ovarian reserve marker anti-Müllerian hormone (AMH) across the adult lifespan. These were most striking in women over the age of 25, Chinese women having lower AMH concentrations than their European counterparts, and this disparity widened with increasing age.