Anti-Mullerian-hormone levels during pregnancy and postpartum

Angela Köninger, Alexis Kauth, Boerge Schmidt, Markus Schmidt, Guelen Yerlikaya, Sabine Kasimir-Bauer, Rainer Kimmig, Cahit Birdir, Angela Köninger, Alexis Kauth, Boerge Schmidt, Markus Schmidt, Guelen Yerlikaya, Sabine Kasimir-Bauer, Rainer Kimmig, Cahit Birdir

Abstract

Background: The number of unintentionally childless couples is increasing as more couples seek to conceive for the first time in the third or fourth decade of the woman's life. Determination of ovarian reserve is an essential component of infertility assessment. The Anti-Müllerian-Hormone (AMH) seems to be the most reliable predictor of ovarian reserve. In this study we analyzed AMH in a cohort of pregnant women without fertility impairment to determine age-dependent decline and possible AMH fluctuations during pregnancy and postpartum.

Methods: A total of 554 healthy women aged 16 to 47 years without history of infertility or previous surgery on the ovaries were enrolled in the study between 1995 and 2012. In 450 women, a single measurement of AMH was taken during pregnancy, allowing for cross sectional analysis of trimester- and age-related differences in AMH levels. For another 15 women longitudinal data on AMH levels for all trimesters was recorded. In addition, for 69 women AMH was measured at the time just before and after delivery, and for another 20 AMH was measured just before delivery and once on each of the first four days after delivery. We used AMH-Gen-II ELISA (Beckman Coulter, Immunotech, Webster, USA) for the assessment of AMH levels. Non-parametric statistical tests were used to compare AMH levels between age groups, trimesters and postpartum.

Results: Comparison between the trimesters revealed a significant difference in AMH values at each trimester (first trimester: 1.69 ng/ml (IQR 0.71-3.10), second trimester: 0.8 ng/ml (IQR 0.48-1.41), third trimester: 0.5 ng/ml (IQR 0.18-1.00)). AMH significantly dropped during the course of pregnancy and immediately after delivery, whereas an increase was observed over the first four days postpartum. Women, greater than or equal to 35 years, showed significant lower AMH levels than those <35 years across all trimesters.

Conclusions: AMH levels decrease during pregnancy. The decline in AMH levels during pregnancy indicates ovarian suppression. AMH levels recover quickly after delivery. AMH levels assessed in pregnant women are not an accurate indicator of ovarian reserve, since AMH levels during pregnancy seem not to be independent of gestational age.

Figures

Figure 1
Figure 1
Boxplots illustrating the distribution of AMH levels for each trimester including all age groups.
Figure 2
Figure 2
Boxplots illustrating the distribution of AMH levels for each trimester including women aged ≤27 years.
Figure 3
Figure 3
Boxplots illustrating the distribution of AMH levels for each trimester including women aged 28–34 years.
Figure 4
Figure 4
Boxplots illustrating the distribution of AMH levels for each trimester including women aged ≥ 35 years.
Figure 5
Figure 5
Trends of AMH levels during the course of pregnancy in women with multiple AMH measurements (n=15).
Figure 6
Figure 6
Boxplots illustrating the distribution of AMH levels in women with AMH measurements prepartum and postpartum (n=69).
Figure 7
Figure 7
Boxplots illustrating the distribution of AMH levels in women with AMH measurements prepartum and at each of the first four days postpartum (n=20).

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