Anti-Mullerian Hormone Levels in Regularly Menstruating Nigerian Women

  • OO Olawale
  • VO Dada
  • FM Abbiyesuku
  • OO Eluyera
  • EW Olooto
  • KC Osuji
Keywords: Anti-Mullerian Hormones, Fertility, Follicle Stimulating Hormone, Women, Menstruation, Menopause

Abstract

Background: Studies have shown that serum levels of Anti-Mullerian Hormones (AMH) decrease with age as it is also an early and sensitive marker of ovarian reserve in women in the North American, European and Asian regions. Various research works have also generated data about AMH in the Caucasian, Americans and Asians There was a need to compare these known data with African data.

Objectives: To assess the serum levels of AMH in healthy women of reproductive age and determine the relationship between AMH, age, Body Mass Index, parity and menstrual cycle in healthy regularly menstruating women.

Methods: A cross-sectional study of 200 apparently healthy women aged 21-45 years was carried out between January and May 2014. Serum AMH and FSH levels were measured in the participants using Enzyme-Linked Immunosorbent Assay.

Results: The median AMH value was 4.07ng/mL, while the median FSH value was 9.65mIU/mL. The reference 90% CI of AMH was 0.60 -9.71 ng/ml. There was a significant negative correlation between serum level of AMH and age (r = - 0.718, p<0.001).

Conclusion: The serum AMH levels gradually declined throughout the reproductive lifespan of a woman.

References

Josso N, Cate RL, Picard JY, Vigier B, di Clemente N, Wilson C, et al. Anti-mullerian hormone: the Jost factor. Recent Progress Hormone Res1993; 48: 1-59. https://doi.org/10.1016/b978-0-12-571148-7.50005-1

van Rooij IA, Broekmans FJ, te Velde ER, Fauser BC, Bancsi LF, de Jong FH, et al. Serum anti-Mullerian hormone levels: a novel measure of ovarian reserve. Human Reprod. 2002; 17: 3065-3071. https://doi.org/10.1093/humrep/17.12.3065

Weenen C, Laven JS, Von Bergh AR, Cranfield M, Groome NP, Visser JA, et al. Anti-Mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Molecular Human Reprod 2004; 10:.77-83. https://doi.org/10.1093/molehr/gah015

Themmen AP. Anti-Mullerian hormone: its role in follicular growth initiation and survival and as an ovarian reserve marker. J Natl Cancer Inst Monographs 2005; 34: 18-21. https://doi.org/10.1093/jncimonographs/lgi026

Durlinger AL, Gruijters MJ, Kramer P, Karels B, Kumar TR, Matzuk MM, et al. Anti-Mullerian hormone attenuates the effects of FSH on follicle development in the mouse ovary. Endocrinology 2001; 142: 4891-4899. https://doi.org/10.1210/endo.142.11.8486

Hehenkamp WJ, Looman CW, Themmen AP, de Jong FH, Te Velde ER, Broekmans FJ. Anti-Mullerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. The J Clin Endocrinol Metab 2006; 91: 4057-4063. https://doi.org/10.1210/jc.2006-0331

Hampl R, Snajderova M, Mardesic T. Antimullerian hormone (AMH) not only a marker for prediction of ovarian reserve. Physiol Res 2011; 60: 217-223. https://doi.org/ 10.33549/physiolres.932076

van Rooij IA, Broekmans FJ, Scheffer GJ, Looman CW, Habbema JD, de Jong FH, et al. Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: A longitudinal study. Fertility Sterility 2005; 83: 979-987. https://doi.org/10.1016/j.fertnstert.2004.11.029

Freeman EW, Gracia CR, Sammel MD, Lin H, Lim LC, Strauss JF, 3rd. Association of anti-mullerian hormone levels with obesity in late reproductive-age women. Fertility Sterility 2007; 87: 101-106. https://doi.org/10.1016/j.fertnstert.2006.05.074

Buyuk E, Seifer DB, Illions E, Grazi RV, Lieman H. Elevated body mass index is associated with lower serum anti-mullerian hormone levels in infertile women with diminished ovarian reserve but not with normal ovarian reserve. Fertility Sterility 2011; 95: 2364-2368. https://doi.org/10.1016/j.fertnstert.2011.03.081

Solberg HE. The IFCC recommendation on the estimation of reference intervals. The RefVal program. Clin Chem Laboratory Med 2004; 42: 710-714. https://doi.org/10.1515/CCLM.2004.121

Yoo JH, Kim HO, Cha SW, Park CW, Yang KM, Song IO, et al. Age-specific serum anti-Mullerian hormone levels in 1,298 Korean women with regular menstruation. Clin Exp Reprod Med 2011; 38: 93-97. https://doi.org/10.5653/cerm.2011.38.2.93

Racoubian E, Aimagambetova G, Finan RR, Almawi WY. Age-dependent changes in anti-Mullerian hormone levels in Lebanese females: correlation with basal FSH and LH levels and LH/FSH ratio: a cross-sectional study. BMC Women's Health 2020; 20: 134. https://doi.org/10.1186/s12905-020-00998-4

Seifer DB, Golub ET, Lambert-Messerlian G, Benning L, Anastos K, Watts DH, et al. Variations in serum Mullerian inhibiting substance between white, black, and Hispanic women. Fertility Sterility 2009; 92: 1674-1678. https://doi.org/10.1016/j.fertnstert.2008.08.110

Barad DH, Weghofer A, Gleicher N. Utility of age-specific serum anti-Mullerian hormone concentrations. Reprod Biomed Online 2011; 22: 284-291. https://doi.org/10.1016/j.rbmo.2010.12.002

La Marca A, Giulini S, Tirelli A, Bertucci E, Marsella T, Xella S, et al. Anti-Mullerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Human Reprod 2007; 22: 766-771. https://doi.org/10.1093/humrep/del421

Schipper I, de Jong FH, Fauser BC. Lack of correlation between maximum early follicular phase serum follicle-stimulating hormone concentrations and menstrual cycle characteristics in women under the age of 35 years. Human Reprod 1998; 13: 1442-1448. https://doi.org/10.1093/humrep/13.6.1442

Nelson SM, Yates RW, Fleming R. Serum anti-Mullerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles--implications for individualization of therapy. Human Reprod 2007; 22: 2414-2421. https://doi.org/10.1093/humrep/dem204

Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, et al. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. The J Clin Endocrinol Metab 2003; 88: 5957-5962. https://doi.org/10.1210/jc.2003-030727

Fallat ME, Siow Y, Marra M, Cook C, Carrillo A. Mullerian-inhibiting substance in follicular fluid and serum: a comparison of patients with tubal factor infertility, polycystic ovary syndrome, and endometriosis. Fertility Sterility 1997; 67: 962-965. https://doi.org/10.1016/s0015-0282(97)81417-3

Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC. Anti-Mullerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. The J Clin Endocrinol Metab 2004; 89: 318-323. https://doi.org/10.1210/jc.2003-030932

La Marca A, Volpe A. Anti-Mullerian hormone (AMH) in female reproduction: is the measurement of circulating AMH a useful tool? Clin Endocrinol 2006; 64: 603-610. https://doi.org/10.1111/j.1365-2265.2006.02533.x

Dolleman M, Verschuren WM, Eijkemans MJ, Dolle ME, Jansen EH, Broekmans FJ, et al. Reproductive and lifestyle determinants of anti-Mullerian hormone in a large population-based study. The J Clin Endocrinol Metab 2013; 98: 2106-2115. https://doi.org/10.1210/jc.2012-3995

Halawaty S, ElKattan E, Azab H, ElGhamry N, Al-Inany H. Effect of obesity on parameters of ovarian reserve in premenopausal women. J Obst Gynaecol Canada 2010; 32: 687-690. https://doi.org/10.1016/s1701-2163(16)34573-x

Steiner AZ, Stanczyk FZ, Patel S, Edelman A. Antimullerian hormone and obesity: insights in oral contraceptive users. Contraception 2010; 81: 245-248. https://doi.org/10.1016/j.contraception.2009.10.004

Bragg JM, Kuzawa CW, Agustin SS, Banerjee MN, McDade TW. Age at menarche and parity are independently associated with Anti-Mullerian hormone, a marker of ovarian reserve, in Filipino young adult women. Am J Human Biol 2012; 24: 739-745. https://doi.org/10.1002/ajhb.22309

Published
2021-05-28
Section
Original Research