Anti-Mullerian-hormone levels during pregnancy and postpartum

Angela Köninger,Markus Schmidt,Boerge Schmidt,Sabine Kasimir-Bauer,Guelen Yerlikaya,Cahit Birdir,Alexis Kauth,Rainer Kimmig

doi:10.1186/1477-7827-11-60

Abstract

BackgroundThe number of unintentionally childless couples is increasing as more couples seek to conceive for the first time in the third or fourth decade of the woman’s life. Determination of ovarian reserve is an essential component of infertility assessment. The Anti-Müllerian-Hormone (AMH) seems to be the most reliable predictor of ovarian reserve. In this study we analyzed AMH in a cohort of pregnant women without fertility impairment to determine age-dependent decline and possible AMH fluctuations during pregnancy and postpartum.MethodsA total of 554 healthy women aged 16 to 47 years without history of infertility or previous surgery on the ovaries were enrolled in the study between 1995 and 2012. In 450 women, a single measurement of AMH was taken during pregnancy, allowing for cross sectional analysis of trimester- and age-related differences in AMH levels. For another 15 women longitudinal data on AMH levels for all trimesters was recorded. In addition, for 69 women AMH was measured at the time just before and after delivery, and for another 20 AMH was measured just before delivery and once on each of the first four days after delivery. We used AMH-Gen-II ELISA (Beckman Coulter, Immunotech, Webster, USA) for the assessment of AMH levels. Non-parametric statistical tests were used to compare AMH levels between age groups, trimesters and postpartum.ResultsComparison between the trimesters revealed a significant difference in AMH values at each trimester (first trimester: 1.69 ng/ml (IQR 0.71–3.10), second trimester: 0.8 ng/ml (IQR 0.48–1.41), third trimester: 0.5 ng/ml (IQR 0.18–1.00)). AMH significantly dropped during the course of pregnancy and immediately after delivery, whereas an increase was observed over the first four days postpartum. Women, greater than or equal to 35 years, showed significant lower AMH levels than those <35 years across all trimesters.ConclusionsAMH levels decrease during pregnancy. The decline in AMH levels during pregnancy indicates ovarian suppression. AMH levels recover quickly after delivery. AMH levels assessed in pregnant women are not an accurate indicator of ovarian reserve, since AMH levels during pregnancy seem not to be independent of gestational age.

Highlights

The number of unintentionally childless couples is increasing as more couples seek to conceive for the first time in the third or fourth decade of the woman’s life
AMH levels during pregnancy stratified by trimesters The comparisons between the trimesters in the 450 patients with single AMH measurements revealed significant differences in AMH median values between each trimester
AMH has been considered to be a surrogate marker of ovarian reserve, up to now only a few studies have examined the role of AMH in pregnancy and postpartum

Summary

Introduction

The number of unintentionally childless couples is increasing as more couples seek to conceive for the first time in the third or fourth decade of the woman’s life. The Anti-Müllerian-Hormone (AMH) seems to be the most reliable predictor of ovarian reserve. There has been an increase in the number of unintentionally childless couples with the increase in the average age of first conception. One explanation for this might be a significantly reduced ovarian reserve in older women. There are various known parameters for assessing ovarian reserve, including ovarian volume, antral follicle count, follicle stimulating hormone (FSH) and Inhibin B at the beginning of the menstrual cycle, as well as AntiMüllerian-Hormone (AMH) [4,5]. AMH correlates very well with the sonographically measurable antral follicle count and has been shown to decrease with increasing age [12]. The intake of hormonal substances had up to now been believed to have no significant effect on AMH levels [19]

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