Longitudinal changes in maternal serum concentrations of antimüllerian hormone in individual women during conception cycles and early pregnancy

Serum anti-Müllerian hormone levels in women are unstable in the postpartum period but return to normal within 5 months: a longitudinal study

PURPOSE

Anti-Müllerian hormone (AMH) levels fall during pregnancy but the amount of time required for AMH levels to return to normal has not been accurately determined. We have previously shown that AMH levels have yet to return to normal in some women at 3-months postpartum. In this study, AMH levels were examined at 1- and 5-months postpartum to examine whether AMH levels had returned to normal within this interval.

METHODS

Longitudinal study involving 38 pregnant women, with serum samples taken in the first trimester, third trimester, 1-month postpartum, 5-months postpartum and 4-6 years postpartum. Participants were recruited from a tertiary maternity clinic (single centre). All women in the study were intending to breastfeed exclusively for at least 5 months, with all 38 participants achieving this at 1-month postpartum and 36/38 after 5 months.

RESULTS

Serum AMH concentrations had not returned to expected non-pregnant levels by 1-month postpartum. At 5-months postpartum, mean AMH concentrations were similar to expected non-pregnant levels but the rank order of AMH concentrations was still dissimilar to the non-pregnant state.

CONCLUSIONS

The regulation of AMH secretion appears to be distinctly different in non-pregnant, pregnant and postpartum populations. This may affect the conclusions that can be drawn from AMH measurements in women during pregnancy and the postpartum period.

The anti-Mullerian hormone as a predictor of early pregnancy loss in subfertile women

The aim of this study was to evaluate the predictive value of the anti-Mullerian hormone (AMH) level for early pregnancy loss and to compare the significance of AMH level to age as prognostic factors of pregnancy loss in subfertile women. The outcome of 848 subfertile patients confirmed with intrauterine pregnancies by ultrasound within 1 year of measuring serum AMH level were retrospectively analyzed. Among 848 patients, 206 women were diagnosed with early pregnancy loss. The mean age of the 848 patients was 35.66 ± 3.61 years (range: 26-46 years), and the mean AMH level was 2.95 ± 1.89 (range: 0.14-8.82 ng/mL). There were no significant differences in gravidity, parity, body mass index (BMI), and previous abortion history depending on early pregnancy loss. However, multivariable logistic regression analysis confirmed that the probability of early pregnancy loss is significantly affected by age (odd ratio, 1.079: 1.025-1.135, P = 0.004) and AMH (odd ratio, 0.885: 0.797-0.982, p = 0.022). According to this study, AMH level and age are both powerful predictors of early pregnancy loss. While chronological age is already well known as a factor related to early pregnancy loss, AMH was also considered when individualizing risk prediction for early pregnancy loss.

A pilot longitudinal study of anti-Müllerian hormone levels throughout gestation in low risk pregnancy

BACKGROUND

Anti-Mϋllerian hormone (AMH) plays an important role regulating ovarian sensitivity to follicle-stimulating hormone and luteinizing hormone in folliculogenesis. Anti-Mϋllerian hormone is well established as a biomarker of ovarian reserve but may also have utility in predicting pregnancy outcomes. Few studies have described AMH levels in pregnancy and, among those that have, most have used cross-sectional study designs and are limited to participants seeking fertility treatment. Our aim was to analyze AMH longitudinally in low-risk pregnancies.

METHODS

We conducted a prospective cohort study at Baystate Medical Center, a large tertiary care hospital in Springfield, MA, USA. We recruited women (n = 30) with low risk, singleton pregnancies, aged 18 to 35 years, with BMI between 18 and 40 kg/m2, and without preexisting disease. Anti-Mϋllerian hormone (pmol/L) was measured in plasma samples collected at 5 prenatal care visits throughout gestation.

RESULTS

Anti-Mϋllerian hormone levels varied significantly over gestation (Friedman's analysis of variance, P value < .0001). At gestational weeks 7 to 10, average AMH was 36.7 pmol/L (standard error = 8.1) and at weeks 34 to 37 was 9.5 pmol/L (standard error = 1.9). Initial AMH varied between women, and an overall significant log-linear decline was observed.

CONCLUSIONS

Anti-Mϋllerian hormone varies between women and declines exponentially during pregnancy. The biological mechanism of the heterogeneity of AMH decline over gestation is unclear. Future studies evaluating AMH throughout pregnancy that also assess gravid health and pregnancy outcomes are warranted.

A putative role for anti-Müllerian hormone (AMH) in optimising ovarian reserve expenditure

The mammalian ovary has a finite supply of oocytes, which are contained within primordial follicles where they are arrested in a dormant state. The number of primordial follicles in the ovary at puberty is highly variable between females of the same species. Females that enter puberty with a small ovarian reserve are at risk of a shorter reproductive lifespan, as their ovarian reserve is expected to be depleted faster. One of the roles of anti-Müllerian hormone (AMH) is to inhibit primordial follicle activation, which slows the rate at which the ovarian reserve is depleted. A simple interpretation is that the function of AMH is to conserve ovarian reserve. However, the females with the lowest ovarian reserve and the greatest risk of early reserve depletion have the lowest levels of AMH. In contrast, AMH apparently strongly inhibits primordial follicle activation in females with ample ovarian reserve, for reasons that remain unexplained. The rate of primordial follicle activation determines the size of the developing follicle pool, which in turn, determines how many oocytes are available to be selected for ovulation. This review discusses the evidence that AMH regulates the size of the developing follicle pool by altering the rate of primordial follicle activation in a context-dependent manner. The expression patterns of AMH across life are also consistent with changing requirements for primordial follicle activation in the ageing ovary. A potential role of AMH in the fertility of ageing females is proposed herein.