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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Endocrinol. | doi: 10.3389/fendo.2018.00686

Anti-Müllerian hormone during natural cycle presents significant intra and intercycle variations when measured with fully automated assay.

 Laura Melado1*,  Barbara Lawrenz1,  Junard Sibal1, Emmanuel Abu1, Carol Coughlan1,  Alfredo Navarro2 and Human Fatemi1
  • 1IVI Middle East Fertility Clinic LLC, United Arab Emirates
  • 2Fundación IVI, Spain

Anti-Müllerian hormone (AMH) is an important ovarian reserve marker for baseline assessment and therapeutic strategy in fertility treatments, which is considered reliable when measured on any day of the cycle. Recent data have pointed towards significant fluctuations of AMH and questioned whether a single measurement is reliable for clinical decision-making. The aim of this study was to evaluate whether the AMH does have significant variations during a natural cycle when a fully automated assay is used for the sample analysis. We performed a prospective study including healthy volunteers with regular cycles, from April to December 2017. Blood samples for AMH, FSH, LH, estradiol and progesterone were obtained on day 2/3, day 10, day of LH surge, luteal phase and day 2/3 of subsequent menses. AMH analysis was performed with Elecsys® AMH automated assay. Trial was registered with clinical.trials.gov: NCT03106272. One hundred samples from 22 women with a mean age of 30.7±4.11 years and a BMI of 23.2±3.63 kg/m² were analysed. There was a substantial longitudinal fluctuation in AMH levels, indicated by the coefficient of variation (CV) intra-cycle of 0.207±0.143. A positive correlation between LH and AMH concentrations was found at the moment of LH rise (p<0.0001). Absolute intra-individual inter-cyclic variability was 0.75 ng/mL (range: 0.03–2.81ng/mL) and inter-cycle CV was 0.28 (Confidence interval: 0.16-0.39; p<0.0001). According to our results, with the use of a fully automated assay in natural cycle, AMH shows significant intra- and inter-cycle variations, which are not caused by analytical variability. Future investigations, evaluating AMH dynamics and the best time for AMH assessment should be conducted.

Keywords: Anti-Müllerian hormone (AMH), Natural cycle, Intra-cycle variations, Inter-cycle variations, Fully automated assay.

Received: 14 Sep 2018; Accepted: 02 Nov 2018.

Edited by:

Katja Teerds, Human and Animal Physiology, Wageningen University, Netherlands

Reviewed by:

Jing Xu, Oregon Health & Science University, United States
Claus Y. Andersen, University of Copenhagen, Denmark
John L. Yovich, Pivet Medical Center, Australia  

Copyright: © 2018 Melado, Lawrenz, Sibal, Abu, Coughlan, Navarro and Fatemi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Laura Melado, IVI Middle East Fertility Clinic LLC, Abu Dhabi, United Arab Emirates, laura.melado@ivivf.com