Age-related nomograms for antral follicle count and anti-Mullerian hormone for subfertile Chinese women in Singapore

Abstract

BackgroundAntral follicle count (AFC) and anti-Mullerian hormone (AMH) are known as the most reliable markers of a woman’s ovarian reserve and are related to age. There is currently no specific local age-related centile charts for AFC and AMH. Therefore, we aim to examine the relationship between AFC and AMH with age and construct age-related nomograms among a subfertile Asian population.MethodsThis is a study involving Chinese women who had their AFC and AMH measured as part of their subfertility screening from December 2010 until November 2014 in KK Women’s and Children’s Hospital, Singapore. Ordinary least squares regression analysis was used to estimate the relationship of AFC and AMH with age, while age-related AFC and AMH nomograms for the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles were produced using the lambda-mu-sigma method.ResultsA total of 1,009 women, aged 26 to 44 year-old, were included. On average, the AFC and AMH decreased respectively by 0.79 follicle (95% confidence interval -0.93, -0.64) and 0.38 ng/mL (95% confidence interval -0.43, -0.32) per year of age. The age-related nomograms of AFC showed an approximately linear pattern, inversely correlated with age, regardless of the percentile. For AMH, the pattern is linear for the 75th percentile and below but shows a slightly accelerating decline for the 90th and 97th percentile. Overall, there were large inter-individual variations in AFC and AMH up to about 40 year-old.ConclusionThe declines of AFC and AMH over age are mostly linear among subfertile Chinese women in Singapore. The age-related AFC and AMH nomograms could be used as a reference chart by fertility practitioners. However, future validation with longitudinal data is required.

Ovarian biomarkers predict controlled ovarian stimulation for in vitro fertilisation treatment in Singapore

“…As AFC and AMH levels decline over age, age-related nomograms can be used as a reference to tailor the ovarian stimulation regime in IVF. (11) The ovarian reserve markers in our study had broadly similar measurements across the different ethnic groups in our study. However, we acknowledge that the small number (n = 62) of patients from minority ethnic groups limited our ability to draw conclusions about interethnic group differences.…”

“…(8,9) There are limited studies on ovarian reserve markers in response to controlled ovarian stimulation in multi-ethnic Southeast Asian women in Singapore. (10,11) This may be important, as it has been shown that AMH level may be influenced by ethnicity. For example, AMH levels can be 25% lower in Afro-American and Hispanic women compared to Caucasians, with genetic polymorphism being implicated.…”

Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function

“…However, studies indicate that at any given age, there is a considerable variation in serum AMH levels ( 14 , 17 , 18 ). Thus, similar to what has been observed for antral follicle count (AFC), large interindividual variation exists for AMH levels ( 19 , 20 ). Ethnicity may contribute to this variation and should be taken into account when interpreting AMH values.…”

Oocyte Cryopreservation before Tumorectomy in Gorlin-Goltz Syndrome with Recurrent Ovarian Fibroma: A Case Report

“…Because she had undergone right salpingo-oophorectomy and left ovarian tumorectomy previously, her AMH level was 1.53 ng/mL. It was reported that the mean AMH level was 4.18 ng/mL in 1009 Chinese women aged 26 -44 years [14]. Thus, our patient's AMH level was relatively low.…”