Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial

Shvetha M Zarek; Emily M Mitchell; Lindsey A Sjaarda; Sunni L Mumford; Robert M Silver; Joseph B Stanford; Noya Galai; Karen C Schliep; Rose G Radin; Torie C Plowden; Alan H DeCherney; Enrique F Schisterman

doi:10.1016/j.fertnstert.2015.12.003

Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial

Zarek SM, Mitchell EM, Sjaarda LA, Mumford SL, Silver RM, Stanford JB, Galai N, Schliep KC, Radin RG, Plowden TC, DeCherney AH, Schisterman EF

Published April 2016 Fertility and sterility, 105(4), 946-952.e2

DOI 10.1016/j.fertnstert.2015.12.003 PMID 26707905 PMC PMC4821799

RRM Academy Synopsis

AMH levels did not predict miscarriage after one or two losses

A cohort study of 1,228 women with one or two earlier pregnancy losses found that antimüllerian hormone (AMH) levels did not predict a new pregnancy loss. In this cohort, women with low, normal or high AMH had no significant difference in loss risk. All were trying to conceive without fertility treatment.

Key Findings

The study included 1,228 women aged 18 to 40 with one or two earlier pregnancy losses, all trying to conceive without fertility treatment. AMH data existed for 1,202 of them.
Among women with AMH data, 185 pregnancy losses occurred: 55 detected by hCG testing and 130 clinical losses.
Women with low AMH had a relative risk of clinical pregnancy loss of 1.13 (95% CI 0.74, 1.72) compared with women with normal AMH.
Women with high AMH had a relative risk of clinical pregnancy loss of 1.13 (95% CI 0.82, 1.56) compared with women with normal AMH.
Losses detected by hCG testing gave the same picture: low AMH 0.90 (95% CI 0.42, 1.91) and high AMH 0.99 (95% CI 0.55, 1.79).

Interpretation

This cohort study followed women with one or two earlier losses who were trying to conceive without fertility treatment, in a group drawn from a trial testing aspirin. The authors say their data do not support routine AMH testing to predict pregnancy loss in women with one or two prior losses. They point to age, plus the number and type of prior losses, as among the most useful facts for counseling these women. The findings support larger studies of AMH and pregnancy loss.

RRM Context

The women were trying to conceive without fertility treatment and used fertility monitors to time sex, a setting close to restorative reproductive medicine. The paper calls AMH a marker of egg supply (ovarian reserve). In this cohort it did not sort women by loss risk. Restorative evaluation of pregnancy loss looks for a cause in the health of both partners and in the cycle.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To evaluate if antimüllerian hormone (AMH) is associated with pregnancy loss.

Design

Prospective cohort study within a block-randomized, double-blind, placebo-controlled trial of low-dose aspirin.

Setting

Not applicable.

Patients

Women (n = 1,228) were of ages 18-40 years with a history of one to two pregnancy losses and were actively attempting pregnancy without fertility treatment.

Interventions

Not applicable.

Main Outcome Measures

Pregnancy loss.

Results

Relative risks (and 95% confidence interval [CIs]) of human chorionic gonadotropin (hCG)-detected and clinical pregnancy loss were assessed with the use of log binomial models with robust variance and inverse probability weights adjusted for age, race, body mass index, income, trial treatment assignment, parity, number of previous losses, and time since most recent loss. AMH levels were defined as: low (<1.00 ng/mL; n = 124), normal (referent; 1.00-3.5 ng/mL; n = 595), and high (>3.5 ng/mL; n = 483). Of the 1,202 women with baseline AMH data, 19 (17.3%) with low AMH experienced a clinical loss, compared with 61 (11.4%) with normal AMH and 50 (11.8%) with high AMH levels. Low or high AMH levels, compared with normal AMH, were not associated with clinical loss. Results for hCG-detected pregnancy loss mirrored those of clinical loss.

Conclusions

AMH values were not associated with hCG-detected or clinical pregnancy loss in unassisted conceptions in women with a history of one to two previous losses. Our data do not support routine AMH testing for prediction of pregnancy loss.

Trial Registration

NCT00467363.

Read the guide

Miscarriage and Recurrent Pregnancy Loss: The Workup Most Women Never Get

Topics

Diagnostics › Hormone Testing › Serum Panels · Pregnancy › Early Pregnancy › Miscarriage · Reproductive Endocrinology › Ovarian Hormones › Estrogen

Shvetha M Zarek, Emily M Mitchell, Lindsey A Sjaarda, Sunni L Mumford, Robert M Silver, Joseph B Stanford, Noya Galai, Karen C Schliep, Rose G Radin, Torie C Plowden, Alan H DeCherney, Enrique F Schisterman

S Zarek, E Mitchell, L Sjaarda, S Mumford, Bob Silver, Rob Silver, Bobby Silver, R Silver, Joe Stanford, Joey Stanford, J Stanford, N Galai, K Schliep, R Radin, T Plowden, A DeCherney, E Schisterman

PMID 26707905 26707905 DOI 10.1016/j.fertnstert.2015.12.003 10.1016/j.fertnstert.2015.12.003 Zarek et al. 2016, Zarek 2016

Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial

AMH levels did not predict miscarriage after one or two losses

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

By this author

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