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Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Reproductive Age Women
  • Published Date:
    Oct 10 2017
  • Source:
    JAMA. 318(14):1367-1376.
Filetype[PDF-624.34 KB]


Details:
  • Pubmed ID:
    29049585
  • Pubmed Central ID:
    PMC5744252
  • Description:
    Importance

    Despite lack of evidence of their utility, biomarkers of ovarian reserve are being promoted as potential markers of reproductive potential or “fertility tests.”

    Objective

    To determine the extent to which biomarkers of ovarian reserve are associated with reproductive potential among late-reproductive age women.

    Design, Setting, and Participants

    Prospective, time-to-pregnancy cohort study (2008-March 2016) of women (N=981) 30–44 years of age without a history of infertility who had been trying to conceive for 3 months or less were recruited from the community in the Raleigh-Durham area.

    Exposures

    Early follicular phase serum level of antimüllerian hormone (AMH), follicle stimulating hormone (FSH), and inhibin B, and urinary level of FSH.

    Main Outcomes and Measures

    The primary outcomes were the cumulative probability of conception by 6 and 12 cycles of attempt and relative fecundability, the probability of conception in a given menstrual cycle. Conception was defined as a positive pregnancy test.

    Results

    750 women (33.3[3.2] years of age; 77% white; 36% overweight or obese), provided a blood and urine sample and were included in the analysis. After adjusting for age, body mass index, race, current smoking status and recent hormonal contraceptive use, women with low AMH values (<0.7ng/ml, N=84) did not have a significantly different predicted probability of conceiving by 6 cycles of attempt (65%; 95% Confidence Interval (CI): 50–75%) compared to women (N=579) with normal values (62%; 95% CI: 57–66%) nor by 12 cycles of attempt (84%; 95% CI: 70–91% versus 75%; 95% CI: 70–79%, respectively). Women with high serum FSH values (>10mIU/ml, N=83) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (63%; 95% CI: 50–73%) compared to women (N=654) with normal values (62%; 95% CI: 57–66%) nor after 12 cycles of attempt (82%; 95% CI: 70–89 versus 75%; 95% CI: 70–78%). Women with high urinary FSH values (>11.5mIU/mgcr, N=69) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (61%; 95% CI: 46–74%) compared to women (N=660) with normal values (62%; 95% CI: 58–66%) nor after 12 cycles of attempt (70%; 95% CI: 54–80% versus 76%; 95% CI: 72–80%). Inhibin b levels (N=737) were not associated with the probability of conceiving in a given cycle (Hazard Ratio [per 1pg/ml increase] = 0.999; 95% CI: 0.997–1.001).

    Conclusions

    Among women age 30–44 years of age without a history of infertility, who had been trying to conceive for 3 months or less, biomarkers indicating diminished ovarian reserve, compared to normal ovarian reserve, were not associated with reduced fertility. These findings do not support the use of urinary or blood FSH tests or AMH levels to assess natural fertility for women with these characteristics.

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