Fertility in women of late reproductive age: the role of serum anti-Müllerian hormone (AMH) levels in its assessment.

B. Meczekalski,M. Kunicki,L. Plociennik,K. Lukaszuk,A. Podfigurna-Stopa,M. Maciejewska-Jeske,G. Jakiel,A. Czyzyk

doi:10.1007/s40618-016-0497-6

Abstract

IntroductionFertility is referred to the capability for having offspring and can be evaluated by fertility rate. Women’s fertility is strictly dependent on individual’s age. The fertility peak occurs in the early 20s, and it starts to decline in the third and fourth decades of life (falling sharply after age 35).AimThe aim of this work is to review the available data concerning fertility in women of late reproductive age, especially the role of serum anti-Müllerian hormone (AMH) levels.Results There are a lot of factors responsible for decrease of fertility in women of late reproductive age. These factors can be classified as oocyte-dependent (decrease in oocyte quantity and quality) and oocyte-independent (reproductive organs [uterus, oviducts] status and general health). Anti-Müllerian hormone (AMH) is a dimeric glycoprotein of the transforming growth factor-β (TGF-β) superfamily produced directly by the ovarian granulosa cells of secondary, preantral, and early antral follicles. It has been used as an ovarian reserve marker since 2002. Anti-Müllerian hormone seems to be the best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women. Evaluation of AMH’s predictive value in the naturally aging population is important for counseling women about reproductive planning as well as for treatment planning for women experiencing hormone-sensitive gynecological conditions such as endometriosis and fibroids.Conclusions AMH can be considered as an indicator of fertility in late reproductive age women and pregnancy outcome in assisted reproductive technology cycles. AMH can strongly predict poor response in the controlled ovarian stimulation.

Highlights

Fertility is referred to the capability for having offspring and can be evaluated by fertility rate
Anti-Müllerian hormone (AMH) can be considered as an indicator of fertility in late reproductive age women and pregnancy outcome in assisted reproductive technology cycles
It is well known that women’s fertility is strictly dependent on individual’s age and that fertility peak occurs in the early 20s and it starts to decline in the third and fourth decades of life [2]

Summary

Introduction

Fertility can be defined as natural capability for having offspring and measured using fertility rate, i.e., the number of live births per 1000 women. In 2003, Fanchin et al demonstrated that antral follicle count (AFC) was closely related to serum AMH level on the third day of cycle in infertile women This correlation was shown to be stronger than with other hormonal markers such as inhibin B, E2, and FSH [32]. Additional studies are required to estimate ability of AMH to predict the chance of spontaneous pregnancy in young and in late reproductive age women. The data still showed that women over 40 years with very low AMH concentrations had a chance of pregnancy [67]. The pregnancy chances for women of advanced reproductive age with low AMH and especially for those over 42 years old are very low but still the available methods fail to dependably predict who will become pregnant

Conclusions

Findings

Compliance with ethical standards