Is Anti-Müllerian Hormone Associated With Fecundability? Findings From the EAGeR Trial

Shvetha M Zarek; Emily M Mitchell; Lindsey A Sjaarda; Sunni L Mumford; Robert M Silver; Joseph B Stanford; Noya Galai; Mark V White; Karen C Schliep; Alan H DeCherney; Enrique F Schisterman

doi:10.1210/jc.2015-2474

Reproductive Endocrinology Ovarian Hormones

Is Anti-Müllerian Hormone Associated With Fecundability? Findings From the EAGeR Trial

Zarek SM, Mitchell EM, Sjaarda LA, Mumford SL, Silver RM, Stanford JB, Galai N, White MV, Schliep KC, DeCherney AH, Schisterman EF

Published November 2015 The Journal of clinical endocrinology and metabolism, 100(11), 4215-4221

DOI 10.1210/jc.2015-2474 PMID 26406293 PMC PMC4702454

RRM Academy Synopsis

AMH level was not linked to time to pregnancy after past losses

A prospective cohort study inside a randomized aspirin trial found that low and high AMH were not linked to how quickly women got pregnant. The study followed 1202 women aged 18 to 40 in the United States, all with one or two earlier pregnancy losses. About 2 out of 3 women in each AMH group had a pregnancy detected.

About 7 in 10 women with low AMH had a pregnancy detected by hCG testing. Source: Zarek SM et al., 2015, PMID 26406293.

Study at a glance, prospective cohort study: AMH level was not linked to how quickly women got pregnant — Study at a glance, prospective cohort study of 1202 women aged 18 to 40: AMH level was not linked to how quickly women got pregnant. Source: Zarek SM et al., 2015, PMID 26406293.

Key Findings

Of the 1202 women with a baseline AMH measurement, 124 had low AMH, 595 had normal AMH, and 483 had high AMH.
A pregnancy detected by hCG testing occurred in 82 of 124 women with low AMH (66.1%), 383 of 595 with normal AMH, and 315 of 483 with high AMH (65.2%).
Compared with normal AMH, the unadjusted fecundability odds ratio was 1.05 (95% CI 0.81 to 1.38) for low AMH and 1.09 (95% CI 0.92 to 1.29) for high AMH.
Ultrasound-confirmed pregnancy occurred in 74 of 124 women with low AMH (59.7%), 348 of 595 with normal AMH (58.5%) and 290 of 483 with high AMH (60%).
No association appeared by age or by prior live birth or number of losses. With the last loss over 1 year earlier, high-AMH estimates were below 1 and borderline in adjusted models.

Interpretation

This cohort study followed 1202 women aged 18 to 40 with one or two prior pregnancy losses, within a randomized aspirin trial. Every woman had proven fecundity, an earlier pregnancy that ended in loss. None had infertility, endometriosis, or PMOS (polyendocrine metabolic ovarian syndrome, formerly PCOS). Low and high AMH groups got pregnant at the same rate as normal AMH. Age, prior live birth, and number of losses made no difference. The authors note the findings apply to women with a history of pregnancy loss. They conclude routine AMH testing is not supported for preconception counseling in young, fecund women. The findings support further study of AMH in other groups.

RRM Context

AMH reflects how many small follicles an ovary holds. Restorative reproductive medicine looks for the cause of delayed conception through cycle charting, ovulation, and underlying conditions in both partners. A reserve number alone names no cause, and in this cohort it gave no forecast of time to pregnancy either.

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

Abstract

Objective

The objective of the study was to evaluate whether anti-Müllerian hormone (AMH) is associated with fecundability among women with proven fecundity and a history of pregnancy loss.

Design

This was a prospective cohort study within a multicenter, block-randomized, double-blind, placebo-controlled clinical trial ( clinicaltrials.gov , number NCT00467363).

Setting

The study was conducted at four US medical centers (2006-2012).

Participants

Participating women were aged 18-40 years, with a history of one to two pregnancy losses who were actively attempting pregnancy.

Main Outcome Measures

Time to human chorionic gonadotropin detected and clinical pregnancy were assessed using Cox proportional hazard regression models to estimate fecundability odds ratios (fecundability odds ratios with 95% confidence interval [CI]) adjusted for age, race, body mass index, income, low-dose aspirin treatment, parity, number of previous losses, and time since most recent loss. Analyses examined by preconception AMH levels: 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).

Results

Of the 1202 women with baseline AMH levels, 82 women with low AMH (66.1%) achieved an human chorionic gonadotropin detected pregnancy, compared with 383 with normal AMH (65.2%) and 315 with high AMH level (65.2%). Low or high AMH levels relative to normal AMH (referent) were not associated with fecundability (low AMH: fecundability odds ratios 1.13, 95% CI 0.85-1.49; high AMH: FOR 1.04, 95% CI 0.87-1.24).

Conclusions

Lower and higher AMH values were not associated with fecundability in unassisted conceptions in a cohort of fecund women with a history of one or two prior losses. Our data do not support routine AMH testing for preconception counseling in young, fecund women.

Topics

Reproductive Endocrinology › Ovarian Hormones › Estrogen · Diagnostics › Hormone Testing › Serum Panels · Fertility Awareness › Biomarkers › Urinary Hormone Monitoring

Shvetha M Zarek, Emily M Mitchell, Lindsey A Sjaarda, Sunni L Mumford, Robert M Silver, Joseph B Stanford, Noya Galai, Mark V White, Karen C Schliep, 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, M White, K Schliep, A DeCherney, E Schisterman

PMID 26406293 26406293 DOI 10.1210/jc.2015-2474 10.1210/jc.2015-2474 Zarek et al. 2015, Zarek 2015

Is Anti-Müllerian Hormone Associated With Fecundability? Findings From the EAGeR Trial

AMH level was not linked to time to pregnancy after past losses

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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