Abstract
BackgroundAMH levels determined by the conventional AMH assay declined during pregnancy and postpartum. A new Beckman Coulter AMH Gen II assay removes the potentially assay-interfering complement which is activated in pregnancy. The aim of this study was to evaluate if the decline of AMH levels in the serum of pregnant women during the course of pregnancy and peripartum was assay-dependent and thus artificial.MethodsIn this cross-sectional study prepartal blood samples were collected from 62 patients (median age 30.6 years [interquartile range: 25.6 - 34.5]) in the third trimester of pregnancy and again 1–4 days after delivery between 2011 and 2012. In another cohort of 11 patients (median age 34.1 years [interquartile range: 32.6 - 37.8]) blood samples were taken in different trimesters of pregnancy between 1995 and 2001. The conventional and the modified AMH assay were performed in the same patient serum samples. We used the conventional and the modified AMH-Gen-II ELISA (Beckman Coulter, Immunotech, Webster, USA) for the assessment of AMH levels. The Wilcoxon signed rank test was used for determining differences between AMH levels pre- and postpartum. The method of Bland and Altman was applied for analyzing the agreement of both methods for determining AMH levels.ResultsAMH values peripartum were lower than those expected in fertile non-pregnant women of comparable age. An overall mean difference of 0.44 ng/ml was observed between the conventional and the modified assay. Measurements with the modified assay showed a significant decline of postpartal levels compared with prepartal levels which is consistent with values obtained using the conventional assay (both p < 0.00001). Compared to the longitudinal measurements of AMH levels determined using the conventional assay, AMH levels obtained using the modified assay suggest a steeper decline of values during the course of pregnancy.ConclusionBy comparing the conventional assay for AMH determination with the modified assay the present study confirmed that AMH levels decline during the course of pregnancy and early after delivery.
Highlights
Anti-Mullerian Hormone (AMH) levels determined by the conventional AMH assay declined during pregnancy and postpartum
Recent studies have suggested that storage conditions led to fluctuations of AMH values determined by this assay, whereas a modified AMH Beckman Coulter Gen II Assay resulted in more stable values of AMH independent of storage time and conditions [10, 11]
The results suggest that differences between both assays increase with rising AMH values irrespective of whether AMH was assessed pre- or postpartally
Summary
AMH levels determined by the conventional AMH assay declined during pregnancy and postpartum. A new Beckman Coulter AMH Gen II assay removes the potentially assay-interfering complement which is activated in pregnancy. Anti-Mullerian Hormone (AMH) is known to be the most precise predictor of ovarian reserve in women [1, 2] It is produced by the granulosa cells of small antral and preantral follicles and reflects the size of the pool of these follicles [3, 4]. Recent studies have suggested that storage conditions led to fluctuations of AMH values determined by this assay, whereas a modified AMH Beckman Coulter Gen II Assay (available since July 2013) resulted in more stable values of AMH independent of storage time and conditions [10, 11]. The modified assay includes a pre-mixing step with a highly anionic buffer which removes this complement
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