Variation in antimüllerian hormone concentration during the menstrual cycle may change the clinical classification of the ovarian response

Capsule:
Antimüllerian hormone varies according to the stage of the menstrual cycle, and the day of blood collection may alter the clinical classification of ovarian response in women seeking fertility therapy.

Authors:
Narelle Hadlow, M.B.B.S., F.R.C.P.A., Katherine Longhurst, B.Sc., Allison McClements, Jay Natalwala, M.B.B.Ch., F.R.A.N.Z.C.O.G., Suzanne J. Brown, B.Sc., Phillip L. Matson, Ph.D.

Volume 99, Issue 6, Pages 1791-1797, May 2013

Abstract:

Objective:
To assess the variability of antimüllerian hormone (AMH) concentrations in women with “adequate ovarian reserve” during unstimulated menstrual cycles and to determine the impact on clinical classifications.

Design:
Pilot cohort study.

Setting:
Private fertility clinic.

Patients:
Twelve consecutive women (aged 29-43 years) referred to a fertility service, having AMH repeated throughout unstimulated cycle and with at least one AMH indicating “adequate ovarian reserve.”

Interventions:
None.

Main outcome measures:
AMH concentrations were assessed in 82 serum samples from 12 women against published cut-offs for reduced ovarian reserve and risk of excessive response to ovarian stimulation.

Results:
Over half the women (7/12) women were re-classified by testing AMH at different phases of the menstrual cycle, with over one third (4 or 5/12) crossing a cut-off for reduced ovarian reserve and 2/12 crossing cut-offs predicting hyperstimulation. There was a significant change in AMH with day of cycle and a negative trend of median AMH from follicular to luteal phase. The maximum change in median AMH over cycle was 7.9 pmol/L and the mean difference between maximum and minimum AMH was 6.7 pmol/L.

Conclusions:
In this pilot study, AMH varied during menstrual cycle, and clinical classification of ovarian response was altered.

  • Mª Gemma Serrano

    This study is very interesting. It is the first paper that I have read about AMH
    variability during menstrual cycle. In my lab we use AMH levels to offer or not
    an IVF cycle to the patiens so I would need to know in which moment of the
    menstrual cycle I would have to measure it. Could you indicate me which is the
    standard deviation obtained in median AMH ( 7.9 pmol/L) to be able to know the “n” that I need to reproduce your results? Thanks in advance.

  • Mª Gemma Serrano

    This study is very interesting. It is the first paper that I have read about AMH variability during menstrual cycle. In my lab we use AMH levels to offer or not an IVF cycle to the patiens so I would need to Know in which moment of the menstrual cycle I would have to measure it. To be able to know the “N” that I need to reproduce your results, could you indicate me which is the standard deviation obtained for the median AMH (7.9 pmol/L) and the mean difference between maximum and minimum(6.7 pmol/L). Thanks in advance.

  • Jashoman Banerjee

    AMH is known to be relatively stable within a cycle . Please inform us regardingvdays of variability , type of assay, duration from blood draw till assay, temperature exposure and variations in similar age groups of patients.
    May be the findings might change when larger sample size will be incorporated.
    Thanks for this interesting finding

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