Abstract
BackgroundAnti-Müllerian hormone (AMH) is an important determinant of ovarian reserve in fertility workups in many clinical settings. Thus, we investigated the age dependent decline in AMH specific to the Egyptian population and sought to establish an age dependent reference interval parametrically.MethodsSerum samples were collected from 841 apparently healthy women. AMH was measured using an electro-chemiluminescent technique. Box-Cox power transformation was used to make the AMH distribution Gaussian for parametric derivation of reference intervals.ResultsPower of 0.4 was found optimal for Gaussian transformation of AMH reference values. We demonstrate the strong negative relation between circulating AMH and female age with Spearman’s correlation coefficient of rS = −0.528. Age-specific reference interval was determined for every 5 years of age from 16 to 49, and nomogram was constructed by smoothing the lines connecting adjacent lower and upper reference limits.ConclusionThe age-specific reference intervals and the age-AMH nomogram could be valuable in the clinical practice of in reproductive medicine. To our knowledge, this is the first study to confirm AMH levels in Egyptian females. We were able to explore age-related AMH levels specific to Egyptian females in the fertile age group and to treat skewed AMH data in a multi-step scheme using power transformation. Thus, a more accurate nomogram was constructed accommodating a profile delineated for a wide age range and a rescaled AMH axis improving its usability.
Highlights
The concept of ovarian reserve which reflects the quantity and quality of oocytes is an essential topic as assisted reproduction is gaining popularity over the years
We demonstrate the strong negative relation between circulating Anti-Mullerian hormone (AMH) and female age with Spearman’s correlation coefficient of rS = −0.528
Age-specific reference interval was determined for every 5 years of age from 16 to 49, and nomogram was constructed by smoothing the lines connecting adjacent lower and upper reference limits
Summary
The concept of ovarian reserve which reflects the quantity and quality of oocytes is an essential topic as assisted reproduction is gaining popularity over the years. Among markers of ovarian reserve, AMH has gained particular interest as it exhibits very low intra and inter cycle variability. Serum AMH levels essentially reflect the ovarian follicular pool [3]. The low inter- and intra-cycle variability in serum AMH levels permits random timing of AMH measurement during the menstrual cycle. AMH levels seem to be unmodified under conditions in which endogenous gonadotrophin release is substantially diminished, such as during pregnancy, GnRH agonist and short-term oral contraceptive treatment. This indicates that non-cyclic, FSH-independent ovarian activity persists even when pituitary FSH secretion is suppressed [6]. We investigated the age dependent decline in AMH specific to the Egyptian population and sought to establish an age dependent reference interval parametrically
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