Longitudinal assessment of antimüllerian hormone during pregnancy—relationship with maternal adiposity, insulin, and adiponectin

Purpose To determine if diminished ovarian reserve (measured by maternal antimullerian hormone (AMH) levels), is associated with fetal aneuploidy (determined by prenatal karyotype). Methods This case-control study included 213 women with singleton pregnancies who underwent both serum aneuploidy screening and invasive prenatal diagnosis. 18 patients carrying an aneuploid fetus served as cases and the remaining 195 women with a euploid fetus were controls. Serum AMH was measured using two assays: AMHbc (Beckman-Coulter) and AMHdsl (Diagnostic Systems Laboratories). Karyotypes were determined by chorionic villus sampling or amniocentesis. Results AMHbc levels did not differ between women with an aneuploid fetus and women with a euploid fetus (p= 0.46) and did not predict aneuploidy (ROC Area=0.57). Additionally, AMHbc values declined significantly with advancing gestational age. Conclusions Maternal AMH does not appear to be a marker of fetal aneuploidy in ongoing pregnancies. Contrary to previous reports, we found a significant decline in maternal AMH levels with advancing gestational age.

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 53%

Maternal antimullerian hormone levels do not predict fetal aneuploidy

Plante

Beamon

Schmitt

et al. 2010

“…That study, by Han et al [23], reported very similar age-grouped median AMH values using the revised Gen II assay, despite having a much smaller reference population and slightly different age groupings. As AMH levels are stable from pre-pregnancy through to the first trimester of pregnancy [8][9][10], our AMH reference range is applicable to the non-pregnant fertile population. Furthermore, it is also relevant to samples processed automatically with the Access2 Immunoassay System (Beckman Coulter), as we have found a strong correlation with manually processed samples (152 samples; R 2 =0.99; unpublished data).…”

Section: Discussionmentioning

confidence: 99%

“…AMH levels also correlate strongly with female age [7] and do not vary significantly in the first trimester of pregnancy [8][9][10]. Measurement of serum AMH is used for a number of clinical applications, the most common being to predict the ovarian response to stimulation in infertility treatment Capsule The original Gen II assay significantly underestimates AMH levels suggesting caution is required when interpreting literature and testing results achieved with this assay.…”

Section: Introductionmentioning

confidence: 99%

The original Beckman Coulter Generation II assay significantly underestimates AMH levels compared with the revised protocol

Bonifacio¹,

Bradley²,

Karia³

et al. 2015

Purpose Anti-Müllerian hormone (AMH) is used as a marker for ovarian reserve. Since 2011, the standard test for AMH has been the Beckman Coulter Generation (Gen) II assay. However, in July 2013, the protocol was revised due to falsely low readings. The aim of this study was to compare AMH levels measured with the original and revised Gen II assay and to establish a fertile female reference range for the revised protocol. Methods Serum AMH levels were measured for 492 natural conception first trimester pregnant women using the original and revised Gen II assay. Results The original protocol significantly underestimated AMH levels compared with the revised protocol (p<0.001), the median being 8.4 and 14.2 pmol/L, respectively. In all samples with detectable AMH levels, the revised protocol yielded a higher concentration compared with the original protocol, the magnitude shift ranging from 3.4 to 283.3 % (median 68.0 %). AMH levels measured with the revised protocol were collated to generate an age-specific reference range, with median levels peaking at 27 years then declining with advancing age. The median AMH concentration for ages 20-24 was 17.3 pmol/L, ages 25-29 was 20.5 pmol/L, ages 30-34 was 17.8 pmol/L, ages 35-39 was 10.8 pmol/L, and ages 40-44 was 6.1 pmol/L. Conclusions Our study demonstrated that the original Gen II assay significantly underestimated AMH levels, suggesting caution is required when interpreting literature and testing results achieved with this assay. We also established the revised Gen II assay reference range for AMH in women with unassisted proven fertility.

“…Further evidence for gonadotropin regulation of AMH includes observational data that prolonged suppression with GnRH analogues results in a decline in AMH levels [17]. An additional clinical scenario where prolonged gonadotropin deficiency has been associated with decreased AMH levels is pregnancy [18]. Finally, consistent with the theory that AMH is not fully gonadotropin-independent is the observation that some women with idiopathic hypogonadotropic hypogonadism (IHH) and endogenous gonadotropin deficiency can have low AMH levels.…”

Section: Introductionmentioning

confidence: 90%

Clinical pregnancy in a woman with idiopathic hypogonadotropic hypogonadism and low AMH: utility of ovarian reserve markers in IHH

Chan

Liu

2014

Objective Serum anti-mullerian hormone (AMH) has been proposed as a useful marker of ovarian reserve that is cycleindependent and predictive of outcome in assisted reproduction cycles. However, there is evidence that AMH production is gonadotropin-dependent, and that under the influence of FSH, growing follicles contribute to circulating AMH levels. Therefore, AMH testing may not be universally reflective of the primordial follicle pool in certain conditions. We demonstrate that in patients with idiopathic hypogonadotropic hypogonadism (IHH) and deficient gonadotropin production, AMH and antral follicle count (AFC) may not be reliable markers of ovarian reserve. Design Case report. Setting Fertility clinic at a tertiary academic hospital. Patient A 30-year-old nulligravid patient with IHH who presented for fertility treatment with low FSH (0.3 IU/L), LH (0.1 IU/L), estradiol (77 pmol/L) and AMH levels (0.65 pmol/L), and an unmeasurable AFC. Intervention A three-month course of priming with oral micronized 17β-estradiol, followed by daily injections of human menopausal gonadotropins (hMG). Main outcome measure AMH level and follicular development.