Antimüllerian hormone levels and numbers and sizes of antral follicles in regularly menstruating women of reproductive age referenced to true ovulation day

Capsule:
Antimullerian hormone (AMH) concentrations vary across ovulatory menstrual cycles with a periovulatory base and lower luteal phase levels. The number of antral follicles may be estimated from the level of AMH.

Authors:
Christian Gnoth, Ph.D., Judith Roos, David Broomhead, Ph.D., Julia Schiffner, Dipl.-Stat., Erhard Godehardt, Ph.D., Günter Freundl, Ph.D., Sarah Johnson, Ph.D.

Volume 104, Issue 6, Pages 1535-1543

Abstract:

Objective:
To assess menstrual cycle antimüllerian hormone (AMH) levels in reproductive age women and which/how many follicles substantially produce AMH.

Design:
Prospective study of menstruating women using mixed-effects models to analyze AMH variability and correlation of follicle counts/size classes to AMH levels.

Setting:
Clinic.

Patient(s):
Regular menstruating women with ovulatory cycles (n = 40, aged 18–37 years) and no known subfertility.

Intervention(s):
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).

Main Outcome Measure(s):
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.

Conclusion(s):
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.

Clinical Trial Registration Number:
NCT01802060.

  • Shvetha Zarek

    Hello Dr. Gnoth! Our group also demonstrated a slight peri-ovulatory decrement in AMH (Kissell KA et al. HR 2014) in the Biocycle Study but did not have transvaginal ultrasonography to verify ovulation. This study nicely adds the the ultrasonography component! Very interesting, thank you!!

  • Daniel J. Kaser, MD

    Dear Dr. Gnoth and colleagues,

    Congratulations on this well-executed prospective assessment of fluctuations in serum AMH in fertile patients normalized to the day of ovulation. Your group quite nicely shows a statistically significant decrease in AMH in the periovulatory period. While you concede that this decrease is modest and not expected to affect clinical management, it is certainly hypothesis-generating in terms of the role of AMH in gating follicular recruitment and selection of dominance.

    Thanks for a nice piece.

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