Anti‐Müllerian hormone exhibits a great variation in infertile women with different ovarian reserve patterns

Görkem, Ümit; Küçükler, Ferit Kerim; Toğrul, Cihan; Güngör, Tayfun

doi:10.1111/ajo.12625

Cited by 11 publications

(10 citation statements)

References 24 publications

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“…However, more recently, the stability of AMH concentrations across and between menstrual cycles has been the subject of considerable debate. Some initial clinical studies suggest that AMH is stable across the menstrual cycle, whereas recent findings have suggested substantial fluctuations across the cycle . In addition, the reproducibility of AMH measurements may be influenced by the assay used: older assays are known to exhibit substantial analytical variability, and data obtained with these assays must therefore be interpreted with caution .…”

Section: Introductionmentioning

confidence: 99%

“…Some initial clinical studies suggest that AMH is stable across the menstrual cycle, [9][10][11] whereas recent findings have suggested substantial fluctuations across the cycle. [12][13][14] In addition, the reproducibility of AMH measurements may be influenced by the assay used: older assays are known to exhibit substantial analytical variability, and data obtained with these assays must therefore be interpreted with caution. 15 The clinical implications of such variations may also have been overstated, as previous studies used large step changes in gonadotropin doses at specific AMH thresholds, 4 and the size of these dose adjustments may have masked any effect of AMH variability on oocyte yield.…”

Section: Introductionmentioning

confidence: 99%

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Anti‐Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta

Nelson

Mannaerts

Andersen

et al. 2019

Clinical Endocrinology

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Summary Objective The stability of anti‐Müllerian hormone (AMH) across and between menstrual cycles has been the subject of debate. The objective of this analysis was to study the inter‐ and intracycle variability in repeated measurements and assess the impact on an individualized gonadotropin dosing algorithm and predicted oocyte yield. Design Retrospective analysis of repeat AMH measures from a randomized controlled trial. Patients A total of 1326 women aged 18‐40 years. Measurements Serum AMH levels at screening and at cycle day 2‐3 in up to three ovarian stimulation cycles. AMH variability and its impact on gonadotropin dose and the predicted number of oocytes. Results Repeat serum AMH measurements were strongly correlated within individual women (correlation coefficient 0.92). AMH exhibited limited within‐subject variation (coefficient of variation 23%), a small time‐related decline (mean 6% decrease/y), but no systematic variation across the menstrual cycle. Irrespective of whether the AMH screening value or the AMH at the initiation of ovarian stimulation was used, for women with an AMH level <15 pmol/L, 93% would receive the same gonadotropin dose and attain an identical number of oocytes in 97% of cases. For women with an AMH level ≥15 pmol/L, 80% would receive an individualized dose within ±1.5 μg and 90% would attain ±1 oocyte. Conclusion AMH variability had limited impact on individualized gonadotropin dosing, with 95% of women predicted to obtain an oocyte yield that does not vary beyond 1 oocyte count, irrespective of whether a random or early follicular AMH measurement was used to determine the individualized gonadotropin dose.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anti‐Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta

Nelson

Mannaerts

Andersen

et al. 2019

Clinical Endocrinology

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“…However, recent publications have raised doubts as to the reliability of a single AMH test taken ad-hoc in a natural cycle. Gorkem et al demonstrated that serum AMH levels seem to be higher during the follicular phase as compared to the luteal phase in infertile women with normal, high, and low ovarian reserve ( 14 ). Other authors have described important variability in AMH concentrations during the menstrual cycle, which was deemed higher than the fluctuations expected due to the analysis alone ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Anti-müllerian Hormone During Natural Cycle Presents Significant Intra and Intercycle Variations When Measured With Fully Automated Assay

et al. 2018

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Anti-Müllerian hormone (AMH) is an important ovarian reserve marker for baseline assessment and therapeutic strategy in fertility treatments, which is considered reliable when measured on any day of the cycle. Recent data have pointed toward significant fluctuations of AMH and questioned whether a single measurement is reliable for clinical decision-making. The aim of this study was to evaluate whether the AMH does have significant variations during a natural cycle when a fully automated assay is used for the sample analysis. We performed a prospective study including healthy volunteers with regular cycles, from April to December 2017. Blood samples for AMH, FSH, LH, estradiol, and progesterone were obtained on day 2/3, day 10, day of LH surge, luteal phase and day 2/3 of subsequent menses. AMH analysis was performed with Elecsys® AMH automated assay. Trial was registered with clinical.trials.gov: NCT03106272. One hundred samples from 22 women with a mean age of 30.74 ± 0.11 years and a BMI of 23.23 ± 0.63 kg/m2 were analyzed. There was a substantial longitudinal fluctuation in AMH levels, indicated by the coefficient of variation (CV) intra-cycle of 0.2070 ± 0.143. A positive correlation between LH and AMH concentrations was found at the moment of LH rise (p < 0.0001). Absolute intra-individual inter-cyclic variability was 0.75 ng/mL (range: 0.03–2.81 ng/mL) and inter-cycle CV was 0.28 (Confidence interval: 0.16–0.39; p < 0.0001). According to our results, with the use of a fully automated assay in natural cycle, AMH shows significant intra- and inter-cycle variations, which are not caused by analytical variability. Future investigations, evaluating AMH dynamics and the best time for AMH assessment should be conducted.

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“…However, recent studies have revealed important inter and intracycle variations during ovarian stimulation for ART that cannot be explained only by analytical variability. Serum AMH levels are lower in the luteal phase than the follicular phase (Gorkem et al, 2017). The average intraindividual AMH variability in a menstrual cycle was 20% and this biological variation was at least twice the analytical variation (Hadlow et al, 2016).…”

Section: Discussionmentioning

confidence: 94%

Comparison of Automated Anti-Müllerian Hormone Assays and Antral Follicle Count in Predicting Ovarian Response During Ovarian Stimulation

Tan

Chincholkar

et al. 2019

FandR

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Objective: Various parameters had been used to predict ovarian response. Among them, Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) demonstrate the most favourable analytical and performance characteristics. In this pilot study, we aim to determine the cut-off levels of AMH using automated AMH assays and AFC in the prediction of poor and high responders. Study Design: Prospective study of 43 women between 21 to 45 years old scheduled for assisted reproduction. AMH levels on day 3 of menstruation were analysed using two immunoassay kits, namely the Beckman Coulter Access AMH and the Roche Elecsys AMH on the two automated analysers Beckman Coulter DxI 800 and Roche Cobas e602 respectively. AFC was also assessed on day 3 of menstruation prior to in vitro fertilization (IVF). These were compared with the number of oocytes retrieved after controlled ovarian stimulation. Results: AMH (Beckman Coulter Access AMH and Roche Elecsys AMH) highly correlated with AFC and the number of oocytes retrieved after ovarian stimulation. Beckman Coulter Access AMH was the better predictor for poor ovarian response with ROC [Formula: see text] of 0.83. For the prediction of a high response, AFC had a higher ROC [Formula: see text] of 0.95. Through ROC, the AMH cut-off level for poor ovarian response was 2.23 ng/ml with Beckman Coulter Access AMH and 2.02 ng/ml with Roche Elecsys AMH, while the AMH cut-off for a high ovarian response was 5.19 ng/ml with Beckman Coulter Access AMH and 4.60 ng/ml with Roche Elecsys AMH. For AFC, the cut-off for poor ovarian response was 18 and for high response was 34. Conclusion: AMH and AFC are reliable predictors of ovarian response. Establishment of specific levels may improve individualised controlled ovarian stimulation and optimise the oocyte yield. Larger studies are required to establish these findings.

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Anti‐Müllerian hormone exhibits a great variation in infertile women with different ovarian reserve patterns

Cited by 11 publications

References 24 publications

Anti‐Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta

Anti‐Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta

Anti-müllerian Hormone During Natural Cycle Presents Significant Intra and Intercycle Variations When Measured With Fully Automated Assay

Comparison of Automated Anti-Müllerian Hormone Assays and Antral Follicle Count in Predicting Ovarian Response During Ovarian Stimulation

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