Prospective study into the value of the automated Elecsys antimüllerian hormone assay for the assessment of the ovarian growing follicle pool

Capsule:
An automated antimullerian hormone assay showed good correlations with age and antral follicle count and is a reproducible measure of the growing follicle pool.

Authors:
Richard A. Anderson, M.D., Ph.D., Ellen Anckaert, M.D., Ph.D., Ernesto Bosch, M.D., Didier Dewailly, M.D., Cheryl E. Dunlop, M.D., Daniel Fehr, M.D., Luciano Nardo, M.D., Johan Smitz, M.D., Ph.D., Kelton Tremellen, M.D., Ph.D., Barbara Denk, Ph.D., Andrea Geistanger, Ph.D., Martin Hund, Ph.D.

Volume 103, Issue 4, Pages 1074-1080

Abstract:

Objective:
To evaluate a new fully automated assay measuring antimüllerian hormone (AMH; Roche Elecsys) against antral follicle count in women of reproductive age.

Design:
Prospective cohort study.

Setting:
Hospital infertility clinics and academic centers.

Patient(s):
Four hundred fifty-one women aged 18 to 44 years, with regular menstrual cycles.

Intervention(s):
None.

Main Outcome Measure(s):
AMH and antral follicle count (AFC) determined at a single visit on day 2–4 of the menstrual cycle.

Result(s):
There was a statistically significant variance in AFC but not in AMH between centers. Both AFC and AMH varied by age (overall Spearman rho −0.50 for AFC and −0.47 for AMH), but there was also significant between-center variation in the relationship between AFC and age but not for AMH. There was a strong positive correlation between AMH and AFC (overall spearman rho 0.68), which varied from 0.49 to 0.87 between centers. An agreement table using AFC cutoffs of 7 and 15 showed classification agreement in 63.2%, 56.9% and 74.5% of women for low, medium, and high groups, respectively.

Conclusion(s):
The novel fully automated Elecsys AMH assay shows good correlations with age and AFC in women of reproductive age, providing a reproducible measure of the growing follicle pool.

  • Shvetha Zarek

    The continued controversies of different AMH assays makes the possible efficacy of the new automated, electrochemiluminescence Elecsys system attractive. Can the authors comment on why the assay is calibrated against the unmodified Beckman Coulter AMH Gen II Elisa instead of the modified version? The issue of calibration is very important given the concerns with the Beckman Coulter assay calibrations against Immunotech and DSL assays. In addition, many believe that the inaccuracies in AMH concentrations is due to the dimerized structure of AMH. Can the authors comment on any precautions taken into account in the Elecsys assay that could overcome this?

    • Richard Anderson

      The modification of the Beckman assay was due to complement interference, rather than a matter of calibration. Complement is not an issue with this assay. But yes calibration is a key issue and we really need an independant standard that all can calibrate against.

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