Anti-Mullerian hormone, inhibin B, and antral follicle count in young women with ovarian failure.
BACKGROUND
Ovarian dysfunction is classically categorized on the basis of cycle history, FSH, and estradiol levels. Novel ovarian markers may provide a more direct insight into follicular quantity in hypergonadotropic women.


OBJECTIVE
The objective of the study was to investigate the distribution of novel ovarian markers in young hypergonadotropic women as compared with normogonadotropic regularly menstruating women.


METHODS
This was a nationwide prospective cohort study.


METHODS
The study was conducted at 10 hospitals in The Netherlands.


METHODS
Women below age 40 yr with regular menses and normal FSH (controls; n = 83), regular menstrual cycles and elevated FSH [incipient ovarian failure (IOF); n = 68]; oligomenorrhea and elevated FSH [referred to as transitional ovarian failure (TOF); n = 79]; or at least 4 months amenorrhea together with FSH levels exceeding 40 IU/liter [premature ovarian failure (POF); n = 112].


METHODS
Serum levels of anti-Müllerian hormone (AMH), inhibin B, and antral follicle count (AFC) was measured.


RESULTS
All POF patients showed AMH levels below the fifth percentile (p(5)) of normoovulatory women. Normal AMH levels (>p(5)) could be identified in 75% of IOF, 33% of TOF patients, and 98% of controls. AFC and AMH levels changed with increasing age (P < 0.0001), whereas inhibin B did not (P = 0.26). AMH levels were significantly different between TOF and IOF over the entire age range, whereas AFC became similar for TOF and IOF at higher ages.


CONCLUSIONS
Compared with inhibin B and AFC, AMH was more consistently correlated with the clinical degree of follicle pool depletion in young women presenting with elevated FSH levels. AMH may provide a more accurate assessment of the follicle pool in young hypergonadotropic patients, especially in the clinically challenging subgroups of patients with elevated FSH and regular menses (i.e. IOF) and in hypergonadotropic women with cycle disturbances not fulfilling the POF diagnostic criteria (i.e. TOF).
Knauff
Erik A H
EA
Department of Reproductive Medicine and Gynecology, University Medical Centre, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. knauff@gmail.com
Eijkemans
Marinus J C
MJ
Lambalk
Cornelius B
CB
ten Kate-Booij
Marianne J
MJ
Hoek
Annemieke
A
Beerendonk
Catharina C M
CC
Laven
Joop S E
JS
Goverde
Angelique J
AJ
Broekmans
Frank J M
FJ
Themmen
Axel P N
AP
de Jong
Frank H
FH
Fauser
Bart C J M
BC
D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007265:Inhibins / Q000097:blood*; D006080:Ovarian Follicle / Q000473:pathology*; D016649:Primary Ovarian Insufficiency / Q000097:blood* / Q000473:pathology; D011446:Prospective Studies
C422364:inhibin B; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone