Falsely elevated serum antimüllerian hormone level in a context of heterophilic interference

Capsule:
A case of falsely elevated serum AMH level due to heterophilic interference in an infertile 37-year-old woman with rheumatoid arthritis is reported for the first time.

Authors:
Hélène Cappy, M.D., Pascal Pigny, Ph.D., Maryse Leroy-Billiard, M.D., Didier Dewailly, M.D., Sophie Catteau-Jonard, Ph.D.

Volume 99, Issue 6, Pages 1729-1732, May 2013

Abstract:

Objective:
To describe a case of falsely elevated serum antimüllerian hormone (AMH) level in an infertile 37-year-old woman suffering from rheumatoid arthritis.

Design:
Case report.

Setting:
Lille University IVF center.

Patient:
A 37-year-old woman with rheumatoid arthritis demonstrating a high serum AMH level (74.5 ng/mL) and a low antral follicle count.

Intervention:
Assay with a Heterophilic Blocking Tube (HBT) to avoid heterophilic interference.

Main Outcome Measure(s):
Serum AMH level, ultrasound antral follicle count, hormonal assays on the 4th day of a spontaneous cycle.

Results:
The results of the infertility work-up were as follows: serum AMH: 74.5 ng/mL (15 fold the upper normal limit) (immunoassay: Immunotech®), LH: 3.2 IU/L, FSH: 4.5 IU/L, E2: 27 pg/mL, Prolactin: 10 ng/mL. The Antral Follicle Count (AFC: follicles from 2 to 9 mm) at ultrasound was 7 for both ovaries. As there were discrepancies between the serum AMH level and the results of the infertility work up using the bioassays, we suspected a case of falsely elevated AMH level due to heterophilic interference. A HBT® tube revealed a serum AMH level of 0.63 ng/mL.

Conclusion:
This case illustrates, for the first time, the possibility of falsely high serum AMH level due to heterophilic interference.

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