Low concentration of circulating antimüllerian hormone is not predictive of reduced fecundability in young healthy women A prospective cohort study

Capsule:
Low AMH levels in young healthy women did not predict reduced fecundability. Even after exclusion of women with irregular cycles, the probability of conceiving was reduced in women with high AMH levels.

Authors:
Casper P. Hagen, M.D., Sonja Vestergaard, Ph.D., Anders Juul, Dm.S.C., Niels Erik Skakkebæk, Dm.S.C., Anna-Maria Andersson, Ph.D., Katharina M. Main, Ph.D., Niels Henrik Hjøllund, Ph.D., Erik Ernst, Ph.D., Jens Peter Bonde, Dm.S.C., Richard A. Anderson, Ph.D., Tina Kold Jensen, Ph.D.

Volume 98, Issue 6, Pages 1602-1608.e2, December 2012

Abstract:

Objective:
To evaluate if circulating levels of antimüllerian hormone (AMH) predict fecundability in young healthy women.

Design:
Prospective cohort study.

Setting:
General community.

Participants:
A total of 186 couples who intended to discontinue contraception to become pregnant were followed until pregnancy or for six menstrual cycles.

Intervention:
None.

Main outcome measures:
Fecundability was evaluated by the monthly probability of conceiving, i.e. fecundability ratio (FR). Additionally, circulating levels of LH, FSH, testosterone and SHBG were evaluated in 158 of 186 women.

Results:
Fifty-nine percent of couples conceived during the period of study. Compared to the reference group of women with medium AMH (AMH quintiles 2–4), fecundability did not differ significantly in women with low AMH (AMH quintile 1); FR 0.81; 95% CI 0.44–1.40. By contrast, women with high AMH (AMH quintile 5) had reduced fecundability (FR 0.62; 0.39–0.99) after adjustment for covariates (female age, BMI, smoking, diseases affecting fecundablility, and oligo-zoospermia). Irregular menstrual cycles were more prevalent in women with high AMH compared to women with low or medium AMH, and they had higher levels of LH (geometric mean: 8.4 vs. 5.3 IU/L) and LH/FSH ratio (2.4 vs. 1.8). After exclusion of women with irregular cycles, women with high AMH still had reduced fecundability (FR 0.48; 0.27–0.85) and elevated LH/FSH ratio (2.4 vs. 1.7).

Conclusion:
Low AMH in healthy women in their mid-twenties did not predict reduced fecundability. Even after exclusion of women with irregular cycles, the probability of conceiving was reduced in women with high AMH.

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