A validated model of serum anti-Mullerian hormone from conception to menopause

TL;DR

This study presents the first validated model of serum anti-Mullerian hormone levels from conception to menopause, revealing key inflection points and providing normative data to improve ovarian reserve assessment.

Contribution

The paper develops and validates the first comprehensive model of AMH levels across the entire female lifespan, incorporating new data and identifying critical age-related changes.

Findings

AMH peaks at age 24.5 years

Neonatal and pre-pubertal peaks confirmed

AMH variation is 34% explained by age

Abstract

Background: Anti-Mullerian hormone (AMH) is a product of growing ovarian follicles. The concentration of AMH in blood may also reflect the non-growing follicle (NGF) population, i.e. the ovarian reserve, and be of value in predicting reproductive lifespan. A full description of AMH production up to the menopause has not been reported. Methodology/Principal Findings: By searching the published literature for AMH concentrations in healthy pre-menopausal females, and using our own data (combined n = 3,260) we have generated and robustly validated the first model of AMH concentration from conception to menopause. This model shows that 34% of the variation in AMH is due to age alone. We have shown that AMH peaks at age 24.5 years, followed by a decline to the menopause. We have also shown that there is a neonatal peak and a potential pre-pubertal peak. Our model allows us to generate normative data at all ages. Conclusions/Significance: These data highlight key inflection points in ovarian follicle dynamics. This first validated model of circulating AMH in healthy females describes a transition period in early adulthood, after which AMH reflects the progressive loss of the NGF pool. The existence of a neonatal increase in gonadal activity is confirmed for females. An improved understanding of the relationship between circulating AMH and age will lead more accurate assessment of ovarian reserve for the individual woman.