Comparison of inter- and intra-cycle variability of anti-Mullerian hormone and antral follicle counts.
BACKGROUND
The antral follicle count (AFC) and anti-Müllerian hormone (AMH) both represent age-related follicular decline quite accurately, although long-term follow-up studies are still lacking. The best ovarian reserve test would need only a single, cycle-independent measurement to be representative.


METHODS
To compare the inter- and intra-cycle stability of AFC and AMH, we used age-adjusted intra-class correlation coefficients (ICCs). To measure inter-cycle stability across a number of up to four menstrual cycles, we used data, prospectively collected for the purpose of an other study, from 77 regularly cycling, infertile women aged 24-40 years. AMH and AFC values were measured on cycle day 3. To study intra-cycle variability, we used data from a prospective cohort study of 44 regularly cycling volunteers, aged 25-46 years and measured AMH and assessed the AFC (2-10 mm) every 1-3 cycle days.


RESULTS
Between menstrual cycles, AFC and AMH varied between 0 and 25 follicles (median 10), and 0.3 and 27.1 ng/ml (median 4.64). The difference in age-adjusted ICC between AMH [ICC, 0.89 (95% CI, 0.84-0.94)] and AFC [ICC, 0.71 (95% CI, 0.63-0.77)] was 0.18 (95% CI, 0.12-0.27). For the intra-cycle variation, 0-43 antral follicles (median 7) were counted per volunteer. The difference in age-adjusted ICC between AMH [ICC, 0.87 (95% CI, 0.82-0.91)] and AFC [ICC, 0.69 (95% CI, 0.46-0.82)] was 0.18 (95% CI, 0.034-0.42).


CONCLUSIONS
Serum AMH demonstrated less individual intra- and inter-cycle variation than AFCs and may therefore be considered a more reliable and robust means of assessing ovarian reserve in subfertile women.
Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, PO Box 85500, Room F.05.126, 3508 GA Utrecht, The Netherlands. j.vandisseldorp-2@umcutrecht.nl
J
J
van Disseldorp
C B
CB
Lambalk
J
J
Kwee
C W N
CW
Looman
M J C
MJ
Eijkemans
B C
BC
Fauser
F J
FJ
Broekmans
D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000097:blood*; D008875:Middle Aged; D006080:Ovarian Follicle / Q000033:anatomy & histology* / Q000502:physiology
D054304:Anti-Mullerian Hormone