Antimüllerian hormone as a risk factor for miscarriage in naturally conceived pregnancies

Abstract

Objective: To determine the association between antimüllerian hormone (AMH), a measure of ovarian reserve, and miscarriage among naturally conceived pregnancies.

Design: Prospective cohort study.

Setting: Not applicable.

Patient(s): Women (n = 533), between 30 and 44 years of age with no known history of infertility, polycystic ovarian syndrome, or endometriosis who conceived naturally.

Intervention(s): None.

Main outcome measure(s): Miscarriage, defined as an intrauterine pregnancy loss before 20 weeks' gestation.

Result(s): After adjusting for maternal age, race, history of recurrent miscarriage, and obesity, risk of miscarriage decreased as AMH increased (risk ratio per unit increase in natural log of AMH = 0.83; 95% confidence interval [CI], 0.73, 0.94). Women with severely diminished ovarian reserve (AMH ≤ 0.4 ng/mL) miscarried at over twice the rate of women with an AMH ≥ 1 ng/mL (hazard ratio, 2.3; 95% CI, 1.3, 4.3).

Conclusion(s): AMH levels are inversely associated with the risk of miscarriage. Women with severely diminished ovarian reserve are at an increased risk of miscarriage.

Keywords: Antimüllerian hormone; diminished ovarian reserve; miscarriage; pregnancy loss.

Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Unadjusted Kaplan Meier curves for time to miscarriage by anti-mϋllerian hormone (AMH) level. (Log Rank test P=0.008)