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.
van Disseldorp
J
J
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
Lambalk
C B
CB
Kwee
J
J
Looman
C W N
CW
Eijkemans
M J C
MJ
Fauser
B C
BC
Broekmans
F J
FJ
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