title: Biological variability in serum anti-Müllerian hormone throughout the menstrual cycle in ovulatory and sporadic anovulatory cycles in eumenorrheic women.
abstract: OBJECTIVE
  Does serum anti-Müllerian hormone (AMH) vary significantly throughout both ovulatory and sporadic anovulatory menstrual cycles in healthy premenopausal women?
  
  
  CONCLUSIONS
  Serum AMH levels vary statistically significantly across the menstrual cycle in both ovulatory and sporadic anovulatory cycles of healthy eumenorrheic women.
  
  
  BACKGROUND
  Studies to date evaluating serum AMH levels throughout the menstrual cycle have conflicting results regarding intra-woman cyclicity. No previous studies have evaluated an association between AMH and sporadic anovulation.
  
  
  METHODS
  We conducted a prospective cohort study of 259 regularly menstruating women recruited between 2005 and 2007.
  
  
  METHODS
  Women aged 18-44 years were followed for one (n = 9) or two (n = 250) menstrual cycles. Anovulatory cycles were defined as any cycle with peak progesterone concentration ≤5 ng/ml and no serum LH peak on the mid or late luteal visits. Serum AMH was measured at up to eight-time points throughout each cycle.
  
  
  RESULTS
  Geometric mean AMH levels were observed to vary across the menstrual cycle (P < 0.01) with the highest levels observed during the mid-follicular phase at 2.06 ng/ml, decreasing around the time of ovulation to 1.79 ng/ml and increasing thereafter to 1.93 (mid-follicular versus ovulation, P < 0.01; ovulation versus late luteal, P = 0.01; mid-follicular versus late luteal, P = 0.05). Patterns were similar across all age groups and during ovulatory and anovulatory cycles, with higher levels of AMH observed among women with one or more anovulatory cycles (P = 0.03).
  
  
  CONCLUSIONS
  Ovulatory status was not verified by direct visualization. AMH was analyzed using the original Generation II enzymatically amplified two-site immunoassay, which has been shown to be susceptible to assay interference. Thus, absolute levels should be interpreted with caution, however, patterns and associations remain consistent and any potential bias would be non-differential.
  
  
  CONCLUSIONS
  This study demonstrates a significant variation in serum AMH levels across the menstrual cycle regardless of ovulatory status. This variability, although statistically significant, is not large enough to warrant a change in current clinical practice to time AMH measurements to cycle day/phase.
  
  
  BACKGROUND
  This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD (Contracts # HHSN275200403394C, HHSN275201100002I Task 1 HHSN27500001). The authors have no conflicts of interest to declare.
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA Program of Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD 20892, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Kissell
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA Office of Biostatistics Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Danaher
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Schisterman
authors.affiliation: Department of Social and Preventive Medicine, University at Buffalo, Buffalo, NY 14214, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wactawski-Wende
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Ahrens
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA.
authors.forename: K
authors.initials: K
authors.lastname: Schliep
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Perkins
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA.
authors.forename: L
authors.initials: L
authors.lastname: Sjaarda
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA.
authors.forename: J
authors.initials: J
authors.lastname: Weck
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), MSC 7510, 6100 Executive Blvd., 7B03, Bethesda, MD 20892, USA mumfords@mail.nih.gov.
authors.forename: S L
authors.initials: SL
authors.lastname: Mumford
mesh_terms: D000328:Adult; D000858:Anovulation / Q000097:blood*; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle / Q000097:blood*; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies
chemical_list: D011374:Progesterone; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone
keywords: anovulation; anti-Müllerian hormone; menstrual cycle