Nomogram of age-specific anti-Müllerian hormone levels in healthy Egyptian females

Abstract

Background Anti-Müllerian hormone (AMH) is an important determinant of ovarian reserve in fertility workups in many clinical settings. Thus, we investigated the age dependent decline in AMH specific to the Egyptian population and sought to establish an age dependent reference interval parametrically. Methods Serum samples were collected from 841 apparently healthy women. AMH was measured using an electro-chemiluminescent technique. Box-Cox power transformation was used to make the AMH distribution Gaussian for parametric derivation of reference intervals. Results Power of 0.4 was found optimal for Gaussian transformation of AMH reference values. We demonstrate the strong negative relation between circulating AMH and female age with Spearman’s correlation coefficient of rS = −0.528. Age-specific reference interval was determined for every 5 years of age from 16 to 49, and nomogram was constructed by smoothing the lines connecting adjacent lower and upper reference limits. Conclusion The age-specific reference intervals and the age-AMH nomogram could be valuable in the clinical practice of in reproductive medicine. To our knowledge, this is the first study to confirm AMH levels in Egyptian females. We were able to explore age-related AMH levels specific to Egyptian females in the fertile age group and to treat skewed AMH data in a multi-step scheme using power transformation. Thus, a more accurate nomogram was constructed accommodating a profile delineated for a wide age range and a rescaled AMH axis improving its usability.

Age Group-specific Reference Intervals for the Elecsys Anti-Müllerian Hormone Assay in Healthy Korean Women: a Nationwide Population-based Study

“…Bleil, et al [17], using the Beckman Coulter ELISA, found that Hispanic women had lower AMH concentrations across all ages, whereas African-American and Chinese women had lower AMH concentrations only at younger (i.e., 25 and 30 years) and middle ages (i.e., 30, 35, and 40 years), respectively, than Caucasian women. In a recent study using the Elecsys assay in Egyptian women, the AMH concentrations across all ages were lower than those in our study or the manufacturer-provided values based on Caucasian populations [12]. In our study, the median AMH concentrations in Korean women of 19-34 years were slightly higher than those shown in the package insert.…”

“…As the 40-44 years, 45-49 years, and 50-54 years age groups exhibited extreme distribu-diabetes mellitus, or hypercholesterolemia, and (4) availability of serum and DNA samples. The participants were divided into seven 5-year age groups: 19-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, 45-49 years, and 50-54 years [7,[10][11][12]. There was a minimum of 120 participants in each group.…”

“…The limit of detection (LOD) and limit of quantitation of Elecsys AMH were 0.07 and 0.21 www.annlabmed.org https://doi.org/10.3343/alm.2022.42.6.621 tions, values within the 95% CI of the upper percentile in the package insert for the corresponding age groups were not excluded. We confirmed the appropriateness of the exclusion by applying the Box-Cox transformation [12]. Reference intervals were calculated using nonparametric methods according to recommendations in the CLSI EP28-A3c guidelines [33].…”

“…Since 2015, automated platforms that use sandwich immunoassays have been developed [5][6][7][8][9]. The automated AMH assays include the Roche Diagnostics Elecsys AMH (Roche Diagnostics GmbH, Mannheim, Germany) and Beckman Coulter Access AMH (Beckman Coulter, Brea, CA, USA) immunoassays, both being currently used in clinical laboratories [6][7][8][9][10][11][12]. According to the 2021 College of American Pathologist AMH-B survey, 56.7% of facilities use Elecsys AMH and 37.3% use Access AMH.…”

Age-specific Reference Intervals for Anti-Müllerian Hormone

“…Recently, automated assays have been developed, and these yield lower AMH levels than ELISA [ 6 , 7 ]. Therefore, it is necessary to establish a reference interval suitable for the new test method [ 8 - 10 ].…”