AGE- AND CONTRACEPTIVE-SPECIFIC ANTI-MÜLLERIAN HORMONE REFERENCE VALUES FROM OVER 25,000 REPRODUCTIVE-AGE WOMEN

Abstract

To determine age-specific median anti-Müllerian hormone (AMH) levels across contraceptive types in healthy women. Women aged 20 to 47 years of age, with no pre-existing comorbidities, who took the Modern Fertility Hormone Test were included in this study. AMH was determined using the Beckman Coulter Access assay, with values 0.1 to 24 ng/mL. Log transformed AMH values were analyzed using fitting generalized additive models (GAMs) accounting for age using quantile regression and assumed as the ratio of medians. For ages 20, 25, 30, 35, 40, and 45, predicted age specific median (95% confidence intervals) levels were assessed. A sensitivity analysis, adjusted for BMI, smoking frequency, CD3, testing lab, and age of menarche, was also performed. 25,763 healthy women reported their use of current contraceptive methods; no birth control: 16499 (64%), copper IUD: 926 (3.6%), hormonal IUD: 2955 (11.5%), implant: 477 (1.9%), progestin-only pill (POP): 260 (1.0%), combined oral contraceptive (OCP): 4059 (15.8%), ring: 587 (2.3%). AMH exhibited age-related declines regardless of the mode of contraception as shown by predicted median values and 95% CI. Median values at age 30 ranged from 3.39 ng/mL to 2.81 ng/mL across contraceptive types. In the adjusted analysis, median values were lower but the relationship was similar.Tabled 1202530354045No contraceptives4.23 (3.64 - 4.92)3.95 (3.78 - 4.11)3.33 (3.24 - 3.41)2.53 (2.46 - 2.60)1.46 (1.39 - 1.52)0.66 (0.59 - 0.74)OCP3.48 (2.76 - 4.40)3.49 (3.27 - 3.72)2.84 (2.72 - 2.97)2.07 (1.94 - 2.20)1.04 (0.90 - 1.19)0.38 (0.26 - 0.57)Hormonal IUD4.77 (3.70 - 6.14)3.97 (3.70 - 4.27)3.33 (3.18 - 3.49)2.51 (2.35 - 2.68)1.48 (1.29 - 1.71)0.73 (0.51 - 1.04)Copper IUD4.60 (3.42 - 6.17)4.12 (3.69 - 4.59)3.39 (3.17- 3.62)2.65 (2.43 - 2.90)1.84 (1.52 - 2.23)1.22 (0.78 - 1.92)Implant3.68 (2.51 - 5.38)3.60 (3.12 - 4.16)3.08 (2.80 - 3.40)2.09 (1.74 - 2.50)1.21 (0.75 - 1.95)0.66 (0.24 - 1.81)POP5.08 (3.06 - 8.43)3.94 (3.18 - 4.88)2.87 (2.53 - 3.25)1.88 (1.62 - 2.19)1.16 (0.85 - 1.59)0.69 (0.35 - 1.36)Ring3.79 (2.48 - 5.80)3.33 (2.77 - 4.02)2.81 (2.58 - 3.06)2.18 (1.97 - 2.41)1.59 (1.26 - 2.01)1.11 (0.66 - 1.89) Open table in a new tab Understanding and interpreting ovarian reserve in contraceptive users has been limited by the lack of comprehensive AMH reference values for various contraceptive methods. These data, the first AMH reference values by age and contraceptive type, may be used to more accurately estimate underlying ovarian reserve among contraceptive users.