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

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.

Figures

Figure 1.

KM cumulative hazard plots illustrating the number of cycles needed to achieve an hCG detected pregnancy in the overall cohort (A), women with no previous live birth (B), women with one previous loss (C), and women with their last loss within 1 year of randomization (D). No significant differences were observed between women with low (blue), normal (green), or high (red) AMH.