Normative values of anti-Müllerian hormone (AMH) in healthy Brazilian adult women: lack of influence of body mass index, smoking habit and contraceptive intake

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 498-531-Female Repro Endocrinology & Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-528
Renata Santos Batista Woloszynek, Berenice Bilharinho Mendonca, Luciana Pinto Brito, Marcelo Cidade Batista, Helena Panteliou Lima Valassi, Cassia Mazi, Luciana Cristina Silva Leopoldino, Marcia Ester Paiva Ferreira, Valéria Samuel Lando and Vinicius N. Brito*
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Background: It has been postulated that AMH can be a good marker of ovarian reserve. The potential clinical applicability of AMH measurement in assisted human reproduction techniques, screening of ovarian failure, as well as for diagnosis of polycystic ovary syndrome is directly related with an appropriate establishment of normative data. In addition, the influence of age, smoking, body mass index (BMI), and contraceptives intake on the values of AMH in women at reproductive age is still controversial. Aims: To establish normative ranges of serum AMH in healthy Brazilian women and evaluate the influence of age, smoking, BMI, and oral contraceptives on the serum AMH values. Subjects and Methods: We prospectively selected serum samples of 84 healthy women aged 18-50 yr with normal menstrual cycle and FSH levels within fertile age. All participants answered a questionnaire containing information about smoking habit, contraceptive intake and BMI. Exclusion criteria included menstrual irregularity, polycystic ovaries syndrome, infertility and gynecological surgeries. AMH levels were assessed by a second-generation immunoassay AMH Gen II ® (Beckman Coulter Company, TX, USA). Procedures for collecting and determining serum AMH were performed according to manufacturer's guidelines and a validation process was previously conducted. LH, FSH, estradiol (AutoDELFIA, Perkin Elmer) and Inhibin B (Beckman Coulter Company, TX, USA) were also assessed in all subjects. Results: The analytical and functional sensitivity for AMH Gen II ® was 0.02 ng/mL and 0.2 ng/mL respectively. The intra-assay coefficient variation was 5.5% and 9%, and inter-assay was 6.4% and 5.9% at low and high AMH levels, respectively. LH, FSH, estradiol and Inhibin B levels were within the normal range in all subjects. No statistically significant difference was found between the AMH levels in smokers and nonsmokers (p = 0.963), as well as between those with and without contraceptives intake (p= 0.969). In all 84 subjects, there was a significant negative correlation between age and serum AMH (r= -0.46; p <0.0001) and a negative, but no significant correlation between BMI and serum AMH (r = -0.117, p = 0.3). Considering the 2.5 - 97.5 percentile, normative values of serum AMH according age were: 18-30 yr (n=43): 0.7 - 12.6 ng/mL; 31-40 yr (n=31): 0.5 - 10.3 ng/mL and 41-50 yr (n=10): 0.2 - 1.2 ng/mL. An overlap in AMH levels was found between women below and over 40 yr. Despite the normal FSH levels and regular menstrual cycle, 16.2% (12/74) of women <40 yr and all women over 40 yr presented AMH <1.2 ng/mL. Conclusions:  We established serum AMH normative values for Brazilian women in fertile age. Smoking habit, body mass index, and contraceptives intake did not influence the serum AMH levels. AMH levels <1.2 ng/mL might predict impaired ovarian reserve despite normal FSH and regular menstrual cycle.

Nothing to Disclose: RSBW, BBM, LPB, MCB, HPLV, CM, LCSL, MEPF, VSL, VNB

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Sources of Research Support: This work was supported by FAPESP grants 2011/21297-0.