Highlights
- •It was not known why the prognostic accuracy of anti-Mullerian hormone (AMH) for determining the time of menopause is limited.
- •According this study, the reason seems to be the poor correlation of the anti-Mullerian hormone concentration with the density of primordial and primary follicles.
- •Serum anti-Mullerian hormone concentrations to estimate the onset of menopause should be used with great care, as misleading interpretation could lead to psychosocial stress and negatively affect family planning.
Abstract
Objectives
To evaluate the prognostic value of anti-Mullerian hormone (AMH) levels in estimating
the ovarian density of primordial and primary follicles, which can be assumed to reflect
the real ovarian reserve.
Study design
A total of 537 women, average age 30.4 years (range 8.0–43.7 years), underwent ovarian
tissue cryopreservation prior to gonadotoxic therapies due to malignant diseases which
do not affect ovarian reserve parameters. Standardized ovarian biopsies were obtained,
and follicular density was analysed. The prognostic accuracy of serum AMH in estimating
ovarian follicle density was evaluated.
Main outcome measures
Histologically determined follicle density, AMH serum concentration and their correlation.
Results
In children, follicle density was high but AMH concentration was low. AMH concentration
was predicted to be maximum at the age of 15.5 years. In women aged over 15.5 years,
the relationship between AMH concentration and follicle density was evaluated. Crude
analysis revealed that serum AMH levels and follicular density were moderately correlated
(r = 0.34, p < 0.001). From the adjusted regression model the predicted value of follicle
density of women aged 20, 30 and 40 years as well as the associated 50 % and 95 %
prediction intervals (50 % PI and 95 % PI, respectively) were calculated. For example,
for women aged 40 years with a serum AMH level of 1 ng/ml, a follicle density of 2.3/mm3 (50 %PI: [1.1, 4.6]; 95 %PI: [0.3, 18]) was predicted. These large prediction intervals
demonstrate the low predictive value of serum AMH for the ovarian follicle density.
Conclusions
Serum AMH levels have limited prognostic value for the follicle density and therefore
for the real ovarian reserve.
Keywords
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Article info
Publication history
Published online: February 04, 2020
Accepted:
February 3,
2020
Received in revised form:
December 21,
2019
Received:
July 16,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
