Low AMH Levels Research Articles

Diagnostic value of miR-199a and miR-21 in the plasma of infertile women with dysregulated AMH levels

This work aimed to explore the expression pattern of circulating miR-199a-3p, miR-21-5p and miR-let7i-3p in infertile women with dysregulated AMH levels. Quantitative real-time PCR was used to measure miR-199a-3p, miR-21-5p, and miR-let7i-3p expression levels in 60 plasma samples of infertile women with low or high AMH levels. Bioinformatic analyses for microRNAs predicting target genes and molecular pathways were performed according to gene ontology (GO) analysis and KEGG pathways. Only miR-199a-3p and miR-21-5p were significantly over and under-expressed, respectively, in the plasma samples of all infertile women with low or high AMH levels versus controls (p-value = 0.01). Furthermore, the diagnostic value miR-199a-3p yielded a receiver operating characteristic (ROC) curve with area under the curve (AUC) of 0.82 with a 95% CI [0.72–0.92] and an AUC of 0.81, for miR-21-5p, 95% CI [0.69–0.92]. The combined ROC curve of miR-21 and miR-199a provided an optimal combination with AUC = 0.98, 95% CI [0.96–1], and, a cut-off point (0.42) which provided 98% sensitivity and 87% specificity. In conclusion, circulating miR-199a-3p and miR-21-5p vary significantly whenever AMH levels of infertile women are disturbed and could potentially serve as non-invasive biomarkers in distinguishing infertile from fertile women.

Diminished ovarian reserve in recurrent pregnancy loss: a systematic review and meta-analysis

To evaluate the association between diminished ovarian reserve (DOR) in women at risk of recurrent pregnancy loss (RPL) using ovarian reserve tests. Systematic review and meta-analysis. University medical schools. Women with a history of RPL. Systematic reviews of major electronic databases (MEDLINE, EMBASE, Web of Science, and Scopus) for studies that evaluated the incidence of DOR in women with RPL. Association between RPL and DOR. In studies up to May 2019 we assessed quality using the Newcastle-Ottawa Scale and meta-analyzed data using a random-effect model. We included 15 studies (n = 3,082 women) reporting on six ovarian reserve tests: antimüllerian hormone [AMH], antral follicle count, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and FSH:LH ratio. More women with RPL seemed to have DOR compared with women who did not have RPL as measured by low AMH levels (odds ratio [OR] 2.77; 95% confidence interval [CI], 1.41-5.46) and AFC (OR 2.45; 95% CI, 1.16-5.19). Women with unexplained RPL also seemed to have a higher association with DOR compared with women whose RPL had a known etiology, as measured by low AMH levels (OR 3.23; 95% CI, 1.81-5.76). No statistically significant differences were found in the levels of any of the remaining ovarian reserve tests between those groups of women. There is an apparent association between DOR and RPL. Low AMH and AFC levels could predict higher odds for pregnancy loss, but more studies are needed to evaluate their prognostic value in the management of women with RPL. Prospero CRD42018114673.

Live birth rate after IVF/ICSI in women with low and extremely low AMH: an age-matched controlled study

BackgroundAn age-matched controlled study, to assess the outcome of IVF/ICSI in low and extremely low AMH levels in different age groups by comparing the live birth rateMaterials and methodsAn age-matched controlled study was done at the Egyptian IVF center, Cairo, Egypt, including 306 infertile women with low AMH levels undergoing IVF/ICSI and an age-matched number of women with normal AMH. The live birth rate in the different age groups according to the AMH level was compared.ResultsThere was no significant difference between LBR in the extremely low AMH arm (11.43%) and low AMH (16.4%) (P = 0.24). The LBR was 30.4% in women with normal AMH as compared to 14.7% in all women with AMH below 1 pg/ml (P = 0.002).The LBR was significantly higher in women below the age of 35 years and women of 35-40 years with normal AMH (33.2% and 31.7%) as compared to LBR in the corresponding age groups with low AMH (18.6% and 13.3%).ConclusionsThere was no difference in the outcome of IVF between patients with low and extremely low AMH levels. Women with normal AMH level resulted in a higher pregnancy rate as compared to women with low AMH level in the same age group. Age is important in determining prognosis of IVF in patients with low levels of AMH.

Dehydroepiandrosterone Supplementation Improves the Outcomes of in vitro Fertilization Cycles in Older Patients With Diminished Ovarian Reserve.

Background: Dehydroepiandrosterone (DHEA) supplementation has been reported to have beneficial effects on the in vitro fertilization (IVF) outcomes of patients with poor ovarian response or diminished ovarian reserve. The Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) stratification is a set of newly established criteria for low prognosis patients. The aim of this study was to examine the potential effects of DHEA supplementation on the IVF outcomes of patients who fulfill the POSEIDON group 4 criteria.Methods: This retrospective cohort study investigated 297 cycles that fulfilled the POSEIDON group 4 criteria and underwent IVF treatment using the gonadotropin-releasing hormone antagonist protocol. The study group contained 159 cycles that received DHEA (30 mg three times per day) daily for 12 weeks before their IVF cycles. The control group included 138 cycles that underwent IVF cycles but did not receive DHEA. The baseline characteristics and cycle parameters as well as the IVF outcomes of both groups were compared.Results: In terms of baseline characteristics, more previous IVF attempts and lower AMH levels were found in the study group than in the control group. Regarding IVF outcomes, patients in the study group had significantly higher follicular oocyte index and higher numbers of retrieved oocytes, metaphase II oocytes, fertilized oocytes, day 3 embryos and top-quality day 3 embryos than those in the control group. Besides, a higher cumulative pregnancy rate and lower cancellation rate were observed in the study group than in the control group although clinical pregnancy rate, live birth rate, and cumulative live birth rate did not differ between the two groups. Whether patients are aged ≤ 40 years or aged > 40, higher numbers of oocytes and embryos were observed in the study group than in the control group. In patients aged > 40, cumulative pregnancy rate was significantly higher in the study group than in the control group.Conclusions: Our data suggest that DHEA supplementation might increase both oocyte and embryo yields, as well as cumulative pregnancy rates, in patients fulfilling the POSEIDON group 4 criteria.

Diferencias en los polimorfismos de genes asociados al control del desarrollo folicular entre búfalos (Bubalus bubalis) y vacunos (Bos indicus)

Associations have been found between genetic polymorphisms and reproductive parameters, this approach additionally would allow us to propose explanations to the phenomena studied. FSHr, InhA, AMH and AMHr are genes associated with follicular development, which have a high homology and the same function in bovines. The objective of this work was to evaluate if some polymorphisms described in other species associated with reproductive parameters are found in two closely related bovines. During 2018, in the Colombian Magdalena Medio anticoagulated blood samples from 50 buffaloes (Bubalus bubalis) and 50 commercial zebu cows (Bos indicus) were taken. All animals without anatomical abnormalities and similar weight and age were taken and the. parity, intercalving period and age at first calving were also recorded. DNA were extracted using Salting out method and the reported polymorphisms of the above mentioned genes were evaluated. Data were compared using Mann Whitney test and p<0.05 value were considered significant. Buffaloes have lower AMH levels, age at first calving, calving interval than Bos indicus cows (p<0.001) and higher parity (p=0.005). The polymorphisms reported in Holstein and humans were not confirmed in any of the samples and species analyzed. The results, are in some way parodoxical because there are differences in reproductive parameters but nothing different in the studies genes. It shows the need to rethink the approach of the study of the association of reproductive and genetic phenomena. Keywords: AMH, AMHr, Buffaloes, FSHr, InhA, Polymorphisms.

The effects of endometrioma size and bilaterality on ovarian reserve

The aim of this study was to investigate the effects of endometrioma (OMAs) size and bilaterality on ovarian reserve. The patients with OMA were determined by ultrasonographic examination. Fifty patients with unilateral OMA (Group A), 30 patients with bilateral OMA (Group B), and 60 women without ovarian cysts (Group C) were included in this study. AMH levels were measured, and antral follicle count (AFC) was determined. The mean serum AMH levels were significantly lower in Group B than Groups C and A, and were significantly lower in Group A than Group C. There was a significant correlation between serum AMH level and OMA size in Group A (R = −.372, p = .008). OMAs per se appear to be associated with damage to the ovarian reserve. Increased OMA size is related to decreased AMH levels in patients with OMA. Bilateral OMAs have a more destructive effect on ovarian reserve.IMPACT STATEMENTWhat is already known on this subject? Previous Studies have demonstrated the effect of surgery on ovarian reserve but there have been contradictory findings reported about the effects of OMAs per se on serum AMH levels and it has not been clear what the relation between OMAs size and AMH levels is, if any.What the results of this study add? In this study, we found decreased AMH levels in patients with OMA. The results showed significant negative correlation between OMA size and AMH levels. The patients with bilateral OMAs had lower AMH levels than the unilateral ones.What the implications are of these findings for clinical practice and/or further research? Increasing OMA size might be harmful to ovarian reserve. Further studies should be done to evaluate whether increasing the size of the OMA is associated with a progressive decline in ovarian reserve and to better clarify the role of the OMAs per se or of laparoscopic surgery in the determination of damage to the ovarian reserve.

A 10-year longitudinal study of evaluation of ovarian reserve in women with transfusion-dependent beta thalassaemia major

ObjectiveAlthough spontaneous fertility and successful pregnancies have been reported in well-chelated and transfused women with beta thalassaemia major (BTM), majority of women are subfertile due to hypogonadotropic hypogonadism (HH). Little is known about the effect of iron overload on ovarian follicles and whether ovarian reserve is affected by the disease or treatment status. This study compares the markers of ovarian reserve in women with transfusion-dependent BTM over a period of ten years with healthy women from a control population. Study designWe performed a 10-year mixed (retrospective and prospective) longitudinal study in 17 women with transfusion-dependent BTM from our thalassaemia clinic between July 2007 to June 2017. The results were compared with 52 age-matched healthy women without any medical conditions (control population) attending our fertility clinic. Patient demographics, medical history, menstrual history, hormonal parameters (serum levels of FSH, estradiol, TSH and AMH) and antral follicle count were recorded in all women from both groups. Serum levels of ferritin, cardiac T2*, liver iron concentration, thyroid function (TSH) and liver function test results were also recorded at three different time points. ResultsSerum AMH levels, estradiol levels and antral follicle count were significantly lower in women with BTM compared with the control group (p < 0.05 for all). Low AMH levels were noted in both groups of women (with and without HH) with a background of BTM. Serum AMH levels positively correlated with AFC in women with BTM. ConclusionSerum AMH level and AFC were significantly lower in women with transfusion dependent BTM as compared to age-matched healthy controls suggesting a direct impact of the disease activity or iron overload on the ovary.

Assessment of ovarian reserve with anti-Mullerian hormone in women following allogeneic hematopoietic cell transplantation

Introduction: Severe ovarian failure and persistent infertility have could be seen in females following allogeneic hematopoietic cell transplantation (allo-HCT.) In this study, the authors aimed to determine the effectiveness of AMH on assessment of ovarian reserve in long-term survivors after allo-HCT. Material and Methods: Female patients, who underwent allo-HCT between August 2009 and February 2016, were retrospectively evaluated for ovarian capacity in long-term follow-up. Twenty-one female patients with a median age of 34 (22-45) years were included in the study. The serum levels of estrogen (E2), follicle stimulated hormone (FSH), luteinizing hormone (LH), and AMH were analysed. Results: The median duration of post-transplant follow-up was 37 (12-84) months. Primary ovarian failure (POF) was detected in eight (38,1%) and 19 (90,4%) cases in the pre-transplant and post-transplant period, respectively. It was found that no menstruation cycles were observed in 18 cases with low AMH levels. Discussion: Regular menstrual cycles may not guarantee the fertilization in the post-transplant period. Combined analysis of hormonal investigations, antral follicle count by vaginal USG, and evaluation of serum AMH levels may be preferred to demonstrate the presence of POF.

Correlation between androgen levels in follicular fluid and granulose cell FSHR expression in poor responder women

Androgen levels are involved in folliculogenesis and follicular maturity. The increase of follicular androgen levels in poor responders can increase FSH receptor expression. However, a previous study found that there was no difference in androgenic follicular fluid levels in poor responder. This discovery led to a theory of differences in FSH receptor density. The objective of this research was to investigate the correlation between androgen levels in follicular fluid with granulose cells FSH receptor expression in poor responder women. This cross-sectional study was completed at the Yasmin IVF Clinic, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Forty-two subjects who underwent IVF were asked to participate and their follicular fluid testosterone and DHEA levels were measured. The patients were classified into two groups consisting of 21 poor responder patients and 21 normo-responder patients. Granulose cells were collected from 17 patients in each group to measure the FSH receptor expression. Correlation between androgens in follicular fluid with granulose cells FSH receptor expression was analyzed using the Spearman test. There were significant between-group differences in mean age with poor responders presenting as older and with lower AMH levels. Testosterone levels from follicular fluid were significantly higher in poor responders, but similar findings were not observed with DHEA levels, which did not rise to the level of statistical significance. There were a significantly lower number of oocytes and cleavage embryos in the poor responder group. Granulose cell FSH receptor expression was higher in the poor responder group, although this difference also did not rise to the level of statistical significance. There was no correlation between testosterone follicular fluid level and granulose cell FSH receptor expression. We found the DHEA follicular fluid level was positively correlated with granulose cell FSH expression, even though the difference was not statistically different. There was no significant correlation between intra-follicular androgen levels and fertilization rates in both poor responders and non-poor responders. Additional studies are needed to find correlations between the other factors affecting poor responders.

The influence of age, body mass index, waist-to-hip ratio and anti-Mullerian hormone level on clinical pregnancy rates in ART

The aim of this study was to estimate the influence of age, body mass index, waist-to-hip ratio and anti-Mullerian hormone levels on clinical pregnancies in assisted reproduction technologies (ART). We used the database of the fertility clinic both the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) units. A total of 1134 treatment cycles from 2013 through 2015 were analyzed. We evaluated clinical pregnancy rate in terms of age, body mass index, waist-to-hip ratio, anti-Mullerian hormone level. The clinical pregnancy rate was 39.9%. The live birth rate was 25.5%. Women who conceived where statistically significantly younger and had lower body mass index. No statistical differences across pregnancy groups were found for waist-to-hip ratio, and anti-Mullerian hormone levels. Low AMH levels do not influence pregnancy rates in younger patients (<36 years).

Anti-Müllerian hormone (AMH) levels in premenopausal breast cancer patients treated with taxane-based adjuvant chemotherapy – A translational research project of the SUCCESS A study

BackgroundPremenopausal women undergoing chemotherapy are at high risk for premature ovarian failure and its long-term consequences. Data on potential markers to evaluate ovarian reserve pre- and posttreatment are limited. Anti-Müllerian hormone (AMH) known for ovarian reserve in reproductive medicine could be a surrogate marker and was assessed in premenopausal breast cancer patients of the SUCCESS A study (EUDRA-CT no. 2005-000490-21). MethodsWe identified 170 premenopausal patients, age ≤ 40 years at trial entry, who received FEC-Doc as taxane-anthracylince based chemotherapy. Blood samples were taken at three time points: Before, four weeks after and two years after adjuvant chemotherapy. Serum AMH-levels were evaluated in a central laboratory by a quantitative immunoassay AMH Gen II ELISA (Beckman Coulter, Brea, USA). ResultsMedian age was 36 years (21–40 years). Median serum AMH-level before chemotherapy was 1.37 ng/ml (range < 0.1–11.3 ng/ml). Four weeks after chemotherapy AMH-levels dropped in 98.6% of the patients to <0.1 ng/ml (range < 0.1–0.21 ng/ml).After two years, 73.3% (n = 101) showed no evidence of ovarian function recovery (AMH <0.1 ng/ml, range < 0.1–3.9 ng/ml). Permanent chemotherapy induced amenorrhea occurred only in 50.6% of the patients. ConclusionsIn this analysis, premenopausal patients showed a high rate of ovarian impairment reflected by low AMH-levels after chemotherapy.

A quantitative comparison of anti-Müllerian hormone measurement and its shifting boundaries between two assays

ObjectiveAnti-Müllerian hormone (AMH), a quantitative marker of ovarian reserve, is used for both clinical and research purposes in the field of reproductive medicine. Numerous AMH assays have been developed. Among other factors, the lack of large-scale comparisons of the various assays hinders the universal interpretation of AMH levels. Moreover, little is known of the practical performance of highly sensitive assays compared with conventional assays with regard to the very low AMH levels found in women nearing menopause. This study aimed to compare the measurements of the Gen II (Beckman Coulter) assay with those of the highly sensitive picoAMH (AnshLabs) assay. MethodsThis cross-sectional study included 1985 premenopausal women who completed the second visit of the population-based Doetinchem Cohort Study, with a mean age of 42±7years. AMH levels were measured with the Gen II and picoAMH assays. Passing-Bablok and Bland Altman analyses were performed and differences in the proportion of detectable samples were assessed. ResultsThe results from the Gen II and picoAMH assays were highly correlated, with a Spearman correlation coefficient of 0.91. The Passing-Bablok regression formula was picoAMH=0.01+1.69*GenII, meaning that on average picoAMH levels were 69% higher than Gen II levels. Of the 670 samples with an undetectable AMH value with the Gen II assay, AMH could be detected in 78% with the picoAMH assay, at a median concentration [interquartile range] of 0.05 [0.01–0.14] ng/mL. ConclusionThese results indicate that, despite a high correlation, there is a large relative difference between results of the Gen II and picoAMH assays. The use of a highly sensitive AMH assay is likely to result in a large increase in the proportion of samples with detectable levels. This may enable research into women’s health across the menopausal transition and research into the potential clinical benefits of distinguishing between women with very low ovarian reserve.

항문암 수술 후 혈중 항뮬러관 호르몬 저하 및 자궁내막이 얇은 난임 환자의 한약치료 자연임신 1례

Objectives: This paper is to report a spontaneous pregnancy with low AMH level and thin endometrium infertility after Korean medical treatments.Methods: A 38-year old patient who had low AMH level, thin endometrium, sleep disturbance and anxiety happened after anorectal cancer surgery was treated by korean medicine such as herb medications per day for 6 months. And we observed the effects of treatments by improvement of symptoms checking endometrium ultrasonography.Results: After treatments, Symptoms of anxiety and sleep disturbance were improved. The number of ovarian follicle and endometrium thickness were upgraded during artificial pregnancy trials. Finally the patient was a spontaneous pregnancy after failures of one intrauterine insemination and one in vitro fertilization trial.Conclusions: This case shows that the korean medicine has effective option for a patient with low AMH level and thin endometrium infertility. Further ultrasonography would be valid measurements to check the effectiveness of oriental treatments as well as symptoms.

Rescue in vitro maturation (IVM) of immature oocytes in stimulated cycles in women with low functional ovarian reserve (LFOR).

Rescue in vitro maturation (IVM) is currently not a routine procedure in association with in vitro fertilization (IVF). We compared in a prospectively cohort study of 10 patients with normal functional ovarian reserve (NFOR) and of 25 with low functional ovarian reserve (LFOR), defined by abnormally high FSH and/or abnormally low AMH levels), IVM dynamics of immature oocytes. Following controlled ovarian hyperstimulation in IVF cycles, only immature oocytes underwent rescue IVM (for up to 48 h). Oocyte maturation dynamics, fertilization rates, embryo development, and pregnancy rates were then compared between NFOR and LFOR patients. Though proportion of MI and GV oocytes reaching MII stages within 48 h and rate of maturation of MI oocytes did not differ, in women with LFOR significantly more GV oocytes reached MII stage within 24 h (30.4 vs. 66.9 %; P = 0.013), while fertilization rates and embryo generation numbers were similar between both groups. Rescue IVM, thus, produced 1.5 additional embryos for transfer in women with LFOR and 1.6 in patients with NFOR, a highly significant difference in relative improvement in available embryo numbers for LFOR (+60.0 %) and NFOR women (+16.5 %). Rescue IVM, thus, not only demonstrates different time dynamics between women with LFOR and NFOR but also disproportionate efficacy in improving available embryo numbers for transfer in favor of LFOR patients. 1/7 patients, who reached embryo transfer with only embryos produced via rescue IVF conceived and delivered, proving that rescue IVF in women with LFOR also improves pregnancy and delivery chances. Because of the small number of embryos LFOR patients produce, every additional embryo is of considerable potential clinical significance for them, suggesting that rescue IVM in women with LFOR should become routine practice.

The menstrual cycle regularization following d-chiro-inositol treatment in PCOS women: a retrospective study

Polycystic ovary syndrome is characterized by irregular cycles, hyperandrogenism, polycystic ovary at ultrasound and insulin resistance. The effectiveness of d-chiro-inositol (DCI) treatment in improving insulin resistance in PCOS patients has been confirmed in several reports. The objective of this study was to retrospectively analyze the effect of DCI on menstrual cycle regularity in PCOS women. This was a retrospective study of patients with irregular cycles who were treated with DCI. Of all PCOS women admitted to our centre, 47 were treated with DCI and had complete medical charts. The percentage of women reporting regular menstrual cycles significantly increased with increasing duration of DCI treatment (24% and 51.6% at a mean of 6 and 15 months of treatment, respectively). Serum AMH levels and indexes of insulin resistance significantly decreased during the treatment. Low AMH levels, high HOMA index, and the presence of oligomenorrhea at the first visit were the independent predictors of obtaining regular menstrual cycle with DCI. In conclusion, the use of DCI is associated to clinical benefits for many women affected by PCOS including the improvement in insulin resistance and menstrual cycle regularity. Responders to the treatment may be identified on the basis of menstrual irregularity and hormonal or metabolic markers.

Expectant management in the infertile women under aged 35 years with low serum AMH levels

Expectant management in the infertile women under aged 35 years with low serum AMH levels

Evaluation of anti‐Mullerian hormone in the first trimester as a predictor for hypertensive disorders of pregnancy and other adverse pregnancy outcomes

Prediction of pre-eclampsia and adverse pregnancy outcomes with biomarkers has been proposed. AMH is an ovary-specific growth factor, used to predict ovarian reserve, which changes with age similar to the change in age-related fertility. The aim of the study was to determine whether AMH tested in the first trimester of pregnancy was associated with pregnancy hypertension or adverse pregnancy outcomes. Retrospective cohort study of women who delivered singleton fetuses ≥20 weeks' gestation at Royal Hospital for Women, Sydney, Australia (n = 331). AMH was tested in 2011 via Beckman-Coulter Gen II ELISA method on frozen serum collected at the time of first trimester aneuploidy screening (10-13 + 6 weeks' gestation). Outcome data were obtained from the hospital database (ObstetriX). Main outcome measures were pregnancy hypertension (pre-eclampsia and gestational hypertension) and composite adverse pregnancy outcome. The median AMH level was 9.7 pmol/L (interquartile range (IQR) 3.9-17.3). There was a trend towards women with pregnancy hypertension having lower AMH levels than women without pregnancy hypertension (median 5.1 pmol/L, IQR 1.5-13.2 vs 9.4 IQR 3.9-17.3; P = 0.06). After adjusting for BMI ≥25, parity ≥1 and age ≥35, women with an AMH less than the 10th centile had a 3.3-fold increased risk of pregnancy hypertension (OR 3.3, 95% CI 1.2-8.7, P = 0.01). There were no other associations between low AMH concentration and adverse maternal or neonatal outcomes. Women with a very low AMH (1.5 pmol/L) in early pregnancy may have an increased risk of pregnancy hypertension. No other adverse pregnancy outcomes were identified.

Ongoing Pregnancy Rates in Women with Low and Extremely Low AMH Levels. A Multivariate Analysis of 769 Cycles

BackgroundThe ideal test for ovarian reserve should permit the identification of women who have no real chance of pregnancy with IVF treatments consequent upon an extremely reduced ovarian reserve. The aim of the current study was to evaluate pregnancy rates in patients with low AMH levels (0.2–1 ng/ml) and extremely low AMH levels (<0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments.MethodsWe conducted an historical cohort analysis at a tertiary medical center. Serum AMH levels were measured at initial clinic visit and prior to all following treatment cycles in 181 women (769 cycles) with an initial AMH level ≤1 ng/ml, undergoing IVF-ICSI. Main outcome measures were laboratory outcomes and pregnancy rates.ResultsSeventy patients undergoing 249 cycles had extremely low AMH levels (≤0.2 ng/ml), whereas 111 patients undergoing 520 cycles had low AMH levels (0.21–1.0 ng/ml). Number of oocytes retrieved per cycle, fertilized oocytes and number of transferred embryos were significantly lower in the extremely low AMH levels group compared to the low AMH levels (P<0.003). Crude ongoing pregnancy rates were 4.4% for both groups of patients. Among 48 cycles of women aged ≥42 with AMH levels of ≤0.2 ng/ml no pregnancies were observed. But, in patients with AMH levels of 0.2–1.0 ng/ml, 3 ongoing pregnancies out of 192 cycles (1.6%) were observed. However, in a multivariate regression analysis adjusted for age and cycle characteristics, no significant differences in ongoing pregnancy rates per cycle between the two groups were evident. Cumulative pregnancy rates of 20% were observed following five cycles, for both groups of patients.ConclusionsPatients with extremely low AMH measurements have reasonable and similar pregnancy rates as patients with low AMH. Therefore, AMH should not be used as the criterion to exclude couples from performing additional IVF treatments.

Race/ethnic disparities in reproductive age: an examination of ovarian reserve estimates across four race/ethnic groups of healthy, regularly cycling women

To determine whether reproductive age, as indexed by a validated marker of ovarian reserve (antimüllerian hormone [AMH]), varies among women of different race/ethnic backgrounds. Cross-sectional study. Community-based sample. Multiethnic sample of 947 (277 white, 237 African American, 220 Latina, and 213 Chinese) healthy and regularly cycling premenopausal women, ages 25-45. None. AMH level. A multivariate model was fit examining race/ethnicity, covariates, nonlinear terms for age (age(2), age(3)), and body mass index (BMI(2), BMI(3)), and two-way interactions between race/ethnicity and each of the other predictor variables in relation to AMH. After backward elimination, significant effects included race/ethnicity (F = 8.45), age (F = 349.94), race/ethnicity-by-linear age interaction (F = 4.67), age(2) (F = 31.61), and BMI (F = 10.69). Inspection of the significant race/ethnicity-by-linear age interaction showed AMH levels were consistently lower among Latina women compared with white women across all ages, whereas AMH levels were lower among African American and Chinese women compared with the white women at younger and middle ages, respectively. The AMH levels were higher among African American compared with Latina and Chinese women at older ages. Although the results must be considered preliminary, the findings are twofold: African American women may have lower AMH levels at younger ages but experience less of a reduction in AMH with advancing age, and Latina and Chinese women compared with white women may have lower AMH levels, marking a lower ovarian reserve and a possibly increased risk for earlier menopause.

Challenging the validity of AMH: clinical pregnancy rates in patients with very low AMH levels

Challenging the validity of AMH: clinical pregnancy rates in patients with very low AMH levels