title: Antimüllerian hormone levels and numbers and sizes of antral follicles in regularly menstruating women of reproductive age referenced to true ovulation day.
abstract: OBJECTIVE
  To assess menstrual cycle antimüllerian hormone (AMH) levels in reproductive age women and which/how many follicles substantially produce AMH.
  
  
  METHODS
  Prospective study of menstruating women using mixed-effects models to analyze AMH variability and correlation of follicle counts/size classes to AMH levels.
  
  
  METHODS
  Clinic.
  
  
  METHODS
  Regular menstruating women with ovulatory cycles (n = 40, aged 18-37 years) and no known subfertility.
  
  
  METHODS
  Women collected daily urine samples and visited the study center for blood samples/transvaginal ultrasound during one complete menstrual cycle (visits were every 2 days; daily from follicle size >16 mm until postovulation).
  
  
  METHODS
  AMH levels throughout the menstrual cycle, correlated with antral follicles as observed by ultrasound and identification of follicles producing AMH.
  
  
  RESULTS
  Of all antral follicles visible by high-resolution ultrasound, AMH is produced substantially only by follicles up to 7 mm in diameter. For women with basal AMH >1 ng/mL, mean AMH concentrations vary across ovulatory menstrual cycles, showing a statistically significant decrease from -5 to 2 days after objective ovulation; significantly lower mean luteal AMH levels (-7.59% to mean follicular AMH) are detected. The number of antral follicles can be estimated from AMH (ng/mL) levels using the modified Beckman Coulter Generation II AMH assay for any day of the follicular phase.
  
  
  CONCLUSIONS
  AMH concentrations vary across ovulatory menstrual cycles, showing a significant periovulatory decrease. The number of small antral follicles can be estimated from preovulatory AMH levels with relevance for patient management.
  
  
  BACKGROUND
  NCT01802060.
authors.affiliation: Green-IVF, Grevenbroich Endocrinology and IVF Center, Grevenbroich, Germany; Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany. Electronic address: dr.christian.gnoth@green-ivf.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Gnoth
authors.affiliation: Green-IVF, Grevenbroich Endocrinology and IVF Center, Grevenbroich, Germany; Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Roos
authors.affiliation: SPD Development Company, Bedford, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Broomhead
authors.affiliation: Mathematical Institute, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Schiffner
authors.affiliation: Medical Faculty (Biostatistics), Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Erhard
authors.initials: E
authors.lastname: Godehardt
authors.affiliation: Green-IVF, Grevenbroich Endocrinology and IVF Center, Grevenbroich, Germany; Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Freundl
authors.affiliation: SPD Development Company, Bedford, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood / Q000378:metabolism* / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000097:blood / Q000378:metabolism* / Q000652:urine; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000378:metabolism*; D010060:Ovulation / Q000097:blood / Q000378:metabolism* / Q000652:urine; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012098:Reproduction; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D015415:Biomarkers; D054304:Anti-Mullerian Hormone
keywords: Antimüllerian hormone; antral follicles; ovulation