title: Infertile women below the age of 40 have similar anti-Müllerian hormone levels and antral follicle count compared with women of the same age with no history of infertility.
abstract: OBJECTIVE
  Do infertile patients below the age of 40 years have a lower ovarian reserve, estimated by anti-Müllerian hormone (AMH) and total antral follicle count (AFC), than women of the same age with no history of infertility?
  
  
  CONCLUSIONS
  Serum AMH and AFC were not lower in infertile patients aged 20-39 years compared with a control group of the same age with no history of infertility. WHAT IS KNOWN ALREADY?: The management of patients with a low ovarian reserve and a poor response to controlled ovarian stimulation (COS) remains a challenge in assisted reproductive technologies (ART). Both AMH levels and AFC reflect the ovarian reserve and are valuable predictors of the ovarian response to exogenous gonadotrophins. However, there is a large inter-individual variation in the age-related depletion of the ovarian reserve and a broad variability in the levels of AMH and AFC compatible with conception. Women with an early depletion of the ovarian reserve may experience infertility as a consequence of postponement of childbearing. Thus, low ovarian reserve is considered to be overrepresented among infertile patients.
  
  
  METHODS
  A prospective cohort study including 382 women with a male partner referred to fertility treatment at Rigshospitalet, Copenhagen, Denmark during 2011-2013 compared with a control group of 350 non-users of hormonal contraception with no history of infertility recruited during 2008-2010.
  
  
  METHODS
  Included patients and controls were aged 20-39 years. Women with polycystic ovary syndrome were excluded. On Cycle Days 2-5, AFC and ovarian volume were measured by transvaginal sonography, and serum levels of AMH, FSH and LH were assessed.
  
  
  RESULTS
  Infertile patients had similar AMH levels (11%, 95% confidence interval (CI): -1;24%) and AFC (1%, 95% CI: -7;8%) compared with controls with no history of infertility in an age-adjusted linear regression analysis. The prevalence of very low AMH levels (<5 pmol/l) was similar in the two cohorts (age-adjusted odds ratio: 0.9, 95% CI: 0.5;1.7). The findings persisted after adjustment for smoking status, body mass index, gestational age at birth, previous conception and chronic disease in addition to age.
  
  
  CONCLUSIONS
  The comparison of ovarian reserve parameters in women recruited at different time intervals could be a reason for caution. However, all women were examined at the same centre using the same sonographic algorithm and AMH immunoassay.
  
  
  CONCLUSIONS
  This study indicates that the frequent observation of patients with a poor response to COS in ART may not be due to an overrepresentation of women with an early depletion of the ovarian reserve but rather a result of the expected age-related decline in fertility.
  
  
  BACKGROUND
  The study received funding from MSD and the Interregional European Union (EU) projects 'ReproSund' and 'ReproHigh'. The authors have no conflict of interest.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark helene.westring.hvidman@regionh.dk.
authors.forename: H W
authors.initials: HW
authors.lastname: Hvidman
authors.affiliation: The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark.
authors.forename: J G
authors.initials: JG
authors.lastname: Bentzen
authors.affiliation: The Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre Hospital, DK-2650 Hvidovre, Denmark.
authors.forename: L L
authors.initials: LL
authors.lastname: Thuesen
authors.affiliation: The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark.
authors.forename: M P
authors.initials: MP
authors.lastname: Lauritsen
authors.affiliation: Section of Biostatistics, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark.
authors.forename: J L
authors.initials: JL
authors.lastname: Forman
authors.affiliation: The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Loft
authors.affiliation: The Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre Hospital, DK-2650 Hvidovre, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Pinborg
authors.affiliation: The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Nyboe Andersen
mesh_terms: D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015331:Cohort Studies; D016001:Confidence Intervals; D003718:Denmark; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000378:metabolism*; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D065851:Ovarian Reserve; D010062:Ovulation Induction
chemical_list: D054304:Anti-Mullerian Hormone
keywords: anti-Müllerian hormone; antral follicle count; infertility; low ovarian reserve; ovarian aging