title: Anti-Mullerian-hormone levels during pregnancy and postpartum.
abstract: BACKGROUND
  The number of unintentionally childless couples is increasing as more couples seek to conceive for the first time in the third or fourth decade of the woman's life. Determination of ovarian reserve is an essential component of infertility assessment. The Anti-Müllerian-Hormone (AMH) seems to be the most reliable predictor of ovarian reserve. In this study we analyzed AMH in a cohort of pregnant women without fertility impairment to determine age-dependent decline and possible AMH fluctuations during pregnancy and postpartum.
  
  
  METHODS
  A total of 554 healthy women aged 16 to 47 years without history of infertility or previous surgery on the ovaries were enrolled in the study between 1995 and 2012. In 450 women, a single measurement of AMH was taken during pregnancy, allowing for cross sectional analysis of trimester- and age-related differences in AMH levels. For another 15 women longitudinal data on AMH levels for all trimesters was recorded. In addition, for 69 women AMH was measured at the time just before and after delivery, and for another 20 AMH was measured just before delivery and once on each of the first four days after delivery. We used AMH-Gen-II ELISA (Beckman Coulter, Immunotech, Webster, USA) for the assessment of AMH levels. Non-parametric statistical tests were used to compare AMH levels between age groups, trimesters and postpartum.
  
  
  RESULTS
  Comparison between the trimesters revealed a significant difference in AMH values at each trimester (first trimester: 1.69 ng/ml (IQR 0.71-3.10), second trimester: 0.8 ng/ml (IQR 0.48-1.41), third trimester: 0.5 ng/ml (IQR 0.18-1.00)). AMH significantly dropped during the course of pregnancy and immediately after delivery, whereas an increase was observed over the first four days postpartum. Women, greater than or equal to 35 years, showed significant lower AMH levels than those <35 years across all trimesters.
  
  
  CONCLUSIONS
  AMH levels decrease during pregnancy. The decline in AMH levels during pregnancy indicates ovarian suppression. AMH levels recover quickly after delivery. AMH levels assessed in pregnant women are not an accurate indicator of ovarian reserve, since AMH levels during pregnancy seem not to be independent of gestational age.
authors.affiliation: Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. angela.koeninger@uk-essen.de
authors.forename: Angela
authors.initials: A
authors.lastname: Köninger
authors.forename: Alexis
authors.initials: A
authors.lastname: Kauth
authors.forename: Boerge
authors.initials: B
authors.lastname: Schmidt
authors.forename: Markus
authors.initials: M
authors.lastname: Schmidt
authors.forename: Guelen
authors.initials: G
authors.lastname: Yerlikaya
authors.forename: Sabine
authors.initials: S
authors.lastname: Kasimir-Bauer
authors.forename: Rainer
authors.initials: R
authors.lastname: Kimmig
authors.forename: Cahit
authors.initials: C
authors.lastname: Birdir
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D011264:Pregnancy Trimesters / Q000097:blood*; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D054304:Anti-Mullerian Hormone