Anti-mullerian hormone as a marker of ovarian reserve.
OBJECTIVE
To analyse the usefulness of plasma anti-mullerian hormone (AMH) measurement as a tool for assessing ovarian reserve in a general infertility population.


METHODS
Plasma AMH levels were analysed in 238 women aged 18-46 years during day 3-5 of their menstrual cycle. All 238 patients had follicle stimulating hormone (FSH) levels less than 10 i.u./L, suggesting normal ovarian reserve on traditional FSH criteria. Eighty-seven patients gave their consent to correlate their AMH levels with IVF oocyte retrieval outcome. Patients producing > or = 8 oocytes were classified as having normal ovarian reserve, while those producing < or = 4 oocytes were classified as having poor ovarian reserve.


RESULTS
Plasma AMH levels remained relatively static (20-25 pmol/L) from 18 to 29 years of age. By 30 years of age, plasma AMH levels start to drop rapidly, reaching only 10 pmol/L by 37 years. Despite this 50% fall in AMH levels between 29 and 37 years of age, minimal changes in FSH levels were observed. Using a cut off value of 8.1 pmol/L, plasma AMH assessment could predict poor ovarian reserve on a subsequent IVF cycle with a sensitivity of 80% and a specificity of 85%.


CONCLUSIONS
Plasma AMH assessments are superior to FSH in identifying women with reduced ovarian reserve. Anti-mullerian hormone assessment should be considered as a useful adjunct to FSH/oestradiol levels and antral follicle count when estimating ovarian reserve.
Tremellen
Kelton P
KP
Reproductive Medicine Laboratories, South Australia. kelton.tremellen@adelaide.edu.au
Kolo
Michele
M
Gilmore
Alan
A
Lekamge
Dharmawijaya N
DN
D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone; D015415:Biomarkers / Q000097:blood*; D002452:Cell Count; D005260:Female; D005307:Fertilization in Vitro; D005498:Follicular Phase / Q000502:physiology; D006023:Glycoproteins / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D009865:Oocytes / Q000166:cytology*; D010053:Ovary / Q000166:cytology* / Q000502:physiology*; D013735:Testicular Hormones / Q000097:blood*
D015415:Biomarkers; D006023:Glycoproteins; D013735:Testicular Hormones; D054304:Anti-Mullerian Hormone