Age-specific random day serum antimüllerian hormone reference values for women of reproductive age in the general population: a large Chinese nationwide population-based survey - 02/12/22

Doi : 10.1016/j.ajog.2022.07.029

Yongxiu Hao, PhD ^a,^b,^c,^d, Rui Yang, MD, PhD ^a,^b,^c,^d, Jia Li, MD ^a,^b,^c,^d, Zehong Zhou, MD ^e,^f, Weiping Qian, MD ^g, Jian Zhang, MD ^h, Ze Wu, MD ⁱ, Lei Jin, MD ^j, Xueqing Wu, MD ^k, Cuilian Zhang, MD ^l, Beihong Zheng, MD ^m, Jichun Tan, MD ⁿ, Guimin Hao, MD ^o, Shangwei Li, MD ^p, Qin Li, PhD ^a,^b,^c,^d, Danni Zheng, PhD ^a,^b,^c,^d, Yuanyuan Wang, PhD ^a,^b,^c,^d, Rong Li, MD, PhD ^a,^b,^c,^d,^⁎ , Ping Liu, MD, PhD ^a,^b,^c,^d,^⁎ , Jie Qiao, MD, PhD ^a,^b,^c,^d,^⁎
^a Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
^b National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
^c Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
^d Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
^e Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
^f Department of Obstetrics and Gynecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
^g Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
^h Department of Pathophysiology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai, China
ⁱ Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
^j Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
^k Reproductive Medicine Center, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Affiliate Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
^l Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, China
^m Reproductive Medicine Center, Fujian Provincial Maternity and Children’s Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
ⁿ Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
^o Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
^p Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China

^∗Corresponding authors: Jie Qiao, MD, PhD.^∗∗Rong Li, MD, PhD.^∗∗∗Ping Liu, MD, PhD.

Abstract

Background

Antimüllerian hormone, the most reliable biomarker of ovarian reserve, is widely used in various clinical situations. Antimüllerian hormone levels consistently decrease with age. However, there is no standard, age-specific reference values for antimüllerian hormone in women of reproductive age, which limits its application.

Objective

This study aimed to establish age-specific antimüllerian hormone percentile reference values for women of reproductive age.

Study Design

A nationwide, population-based cross-sectional survey was conducted between May 2019 and April 2021 in 15 provinces and municipalities in mainland China. A total of 10,053 eligible women aged 20 to 49 years were selected using a multistage stratified sampling procedure. Women who were pregnant, had undergone ovarian surgery, took hormone drugs in the past 3 months, or had an antimüllerian hormone outlier value were excluded from establishing antimüllerian hormone percentile reference values. Serum antimüllerian hormone concentrations were measured using ultrasensitive, 2-site enzyme-linked immunosorbent assays (Ansh Lab, Webster, TX) in the Reproductive Endocrinology Laboratory of Peking University Third Hospital. Generalized additive models for location scale and shape with the Box-Cox t original distribution were used to estimate the fitted antimüllerian hormone percentile reference values.

Results

A total of 9112 eligible women aged 21 to 49 years were included in the fitting model. The fitted 50th (2.5th–97.5th) percentiles of antimüllerian hormone values for women aged 21, 25, 30, 35, 40, 45, and 49 years were 4.83 (0.79–18.41), 4.47 (0.72–16.58), 3.67 (0.50–13.82), 2.59 (0.24–10.35), 1.35 (0.05–6.68), 0.33 (<0.01 to 3.40), and 0.04 (<0.01 to 1.77) ng/mL, respectively. The population-based decline rate of antimüllerian hormone accelerated with increasing age, especially age >35 years. The magnitude of the decline of the 25th antimüllerian hormone percentile curve was greater than that of the 75th percentile curve.

Conclusion

This study established age-specific antimüllerian hormone percentile reference values for women of reproductive age based on a large representative sample of the general population and described antimüllerian hormone changes. These findings may facilitate antimüllerian hormone application in clinical practices.

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Key words : antimüllerian hormone, ovarian reserve, reference values, reproductive age

Plan

Introduction

Materials and Methods

Study design and participants

Sample preparation and antimüllerian hormone measurement

Results in the context of what is known

Clinical implications

Research implications

Strengths and limitations

Conclusions

	Y.H., R.Y., and J.L. are listed as joint first authors.
	R.L., P.L., and J.Q. are listed as joint corresponding authors.
	The authors report no conflict of interest.
	This work was funded by the National Key Research and Development Program (grant number 2018YFC1002106) and the Beijing Municipal Science and Technology Commission (grant number Z191100006619085). The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.
	Cite this article as: Hao Y, Yang R, Li J, et al. Age-specific random day serum antimüllerian hormone reference values for women of reproductive age in the general population: a large Chinese nationwide population-based survey. Am J Obstet Gynecol 2022;227:883.e1-18.

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Vol 227 - N° 6

P. 883.e1-883.e18 - décembre 2022 Retour au numéro

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Age-specific random day serum antimüllerian hormone reference values for women of reproductive age in the general population: a large Chinese nationwide population-based survey - 02/12/22

Abstract

Background

Objective

Study Design

Results

Conclusion

Plan

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