文摘

Background There has been much interest in the use of anti-Mullerian hormone (AMH) as a biomarker in the assessment of ovarian reserve, and debate on its use as a predictor of assisted reproductive technology (ART) outcomes. Normal levels have not been well defined, and age-based reference ranges may have a role in counselling patients. Aims To determine AMH levels in females attending with subfertility, identify age-specific centiles and the age-related decline, to create population normograms to be used in patient counselling prior to ART. Methods Retrospective study in a tertiary academic Assisted Conception Centre analysing AMH levels in female patients attending for investigation of subfertility between January 2009 and December 2011 (n?=?3,058). Results Few patients have AMH levels within external laboratory pre-defined “normal fertility potential-ranges. Only 8.1?% had “optimal fertility-and 18.6?% “satisfactory- with 54.6?% “low-fertility and 15.9?% in the “very low/undetectable-group. By age 32, over 50?% of women have AMH levels categorised as “low fertility-(AMH ?9.5?pmol/L), increasing to 75?% by age 39. Based on a regression model a decrease in mean AMH of 1.72?pmol/L/year was measured. Conclusions We recommend that each ART centre defines their “own-normograms for accurate advice for and treatment of their patients. External laboratory-defined “normal-and “abnormal-AMH levels should be filtered and adapted to the reality of each population. These findings need to be considered when counselling patients and planning treatments as age-specific population normograms can provide a tailored approach.