title: Serum anti-Mullerian hormone assessment of ovarian reserve and polycystic ovary syndrome status over the reproductive lifespan.
abstract: BACKGROUND
  To determine normal ranges for serum anti-Mullerian hormone (AMH) using the new automated Elecsys AMH assay platform, with a view to establishing values that signify premature loss of ovarian reserve, increased risk for an excessive response during IVF stimulation and a likely diagnosis of polycystic ovary syndrome (PCOS).
  
  
  METHODS
  Serum AMH was measured by the Elecsys automated electrochemiluminescence assay in 654 women undergoing gynaecological assessment.
  
  
  RESULTS
  Serum AMH levels peaked before 25 years of age, with mean AMH levels halving by 36 and falling to a quarter of their peak by 40 years of age. Overall, AMH results of 95% of patients with PCOS exceeded the 50th percentile for their age, with 72.1% having an AMH result in the top quartile for age. ROC analysis suggested that a serum AMH ≥36 pmol L(-1) is the best determinant of PCOS status (sensitivity 83.7% and specificity 82.3%). Serum AMH exhibited an excellent correlation with ultrasound-assessed antral follicle count (AFC) (r = 0.836, P < 0.0001), with a result of 20 pmol L(-1) corresponding to an AFC of 16 and, therefore, increased risk of ovarian hyperstimulation syndrome (OHSS) during IVF treatment.
  
  
  CONCLUSIONS
  Serum AMH is a sensitive marker of age-related decline in ovarian reserve status. A serum AMH result >36 pmol L(-1) , or above the 75th percentile for age, is highly suggestive of a diagnosis of PCOS. A serum AMH result below the 10th percentile for age suggests accelerated loss of ovarian reserve, while an AMH result exceeding 20 pmol L(-1) suggests an increased risk of OHSS during IVF treatment.
authors.affiliation: Repromed, Dulwich, South Australia, Australia.|Department of Obstetrics and Gynaecology, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: Kelton
authors.initials: K
authors.lastname: Tremellen
authors.affiliation: Repromed, Dulwich, South Australia, Australia.
authors.forename: Deidre
authors.initials: D
authors.lastname: Zander-Fox
mesh_terms: D000328:Adult; D000375:Aging / Q000097:blood / Q000502:physiology*; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008163:Luminescent Measurements; D008875:Middle Aged; D016471:Ovarian Hyperstimulation Syndrome / Q000097:blood / Q000175:diagnosis; D065851:Ovarian Reserve / Q000502:physiology*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D012016:Reference Values; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D054304:Anti-Mullerian Hormone
keywords: anti-Mullerian hormone; antral follicle count; assay; ovarian reserve; polycystic ovary syndrome