Association of testosterone and antimüllerian hormone with time to pregnancy and pregnancy loss in fecund women attempting pregnancy

Abstract

Objective: To examine whether higher T and/or antimüllerian hormone (AMH) was associated with anovulation, time to pregnancy (TTP), or pregnancy loss risk among healthy, fecund women without diagnosed polycystic ovary syndrome.

Design: Prospective cohort study conducted as a secondary analysis from the Effects of Aspirin in Gestation and Reproduction randomized trial.

Setting: University medical centers.

Patient(s): A total of 1,198 healthy, eumenorrheic women aged 18-40 years attempting spontaneous pregnancy with one to two prior pregnancy losses were included. Women were categorized by baseline antimüllerian hormone (AMH), as a surrogate marker of antral follicle count, and T concentrations; the highest quartile for each was "high," and below the top quartile (i.e., lower 75% of values) was "norm," forming four groups: norm T/norm AMH (n = 742), norm T/high AMH (n = 156), high T/norm AMH (n = 157), and high T/high AMH (n = 143).

Intervention(s): Not applicable.

Main outcome measure(s): Anovulation, pregnancy incidence, TTP, and pregnancy loss incidence.

Result(s): Women with high T/high AMH had a greater anovulation risk (risk ratio 1.58, 95% confidence interval 1.13-2.22) compared with women with norm T/norm AMH, but with imprecise differences in incidence of pregnancy, TTP, or pregnancy loss.

Conclusion(s): Women with higher T and AMH had more frequent anovulatory cycles but with marginal impacts on TTP or pregnancy loss. A continuum of mild inefficiency in reproductive function may be related to higher T and AMH, including in fecund women with normal menstrual cycles and no clinical diagnosis of polycystic ovary syndrome, but with unclear effects on fecundability and pregnancy loss.

Clinical trial registration number: NCT00467363.

Keywords: Androgen; menstrual cycle; polycystic ovary syndrome; testosterone; time to pregnancy.

Conflict of interest statement

Conflicts of interest: The authors have no competing interests to report.

Published by Elsevier Inc.

Figures

Figure 1

Risk of A) anovulation among first two cycles of study participation and pregnancy incidence, and B) pregnancy losses subcategorized by hCG detected losses and clinically confirmed losses. Dashed line indicates reference group: norm T/norm AMH (n=742). Unadjusted % incidence of indicated outcome provided for each group. Total group sizes were: norm T/high AMH (n=156), high T/norm AMH (n=157), high T/high AMH (n=143).