Anti-Mullerian hormone normogram in an Irish subfertile population

There has been much interest in the use of anti-Mullerian hormone (AMH) as a biomarker in the assessment of ovarian reserve, and debate on its use as a predictor of assisted reproductive technology (ART) outcomes. Normal levels have not been well defined, and age-based reference ranges may have a role in counselling patients.

To determine AMH levels in females attending with subfertility, identify age-specific centiles and the age-related decline, to create population normograms to be used in patient counselling prior to ART.

Retrospective study in a tertiary academic Assisted Conception Centre analysing AMH levels in female patients attending for investigation of subfertility between January 2009 and December 2011 (n = 3,058).

Few patients have AMH levels within external laboratory pre-defined "normal fertility potential" ranges. Only 8.1 % had "optimal fertility" and 18.6 % "satisfactory", with 54.6 % "low" fertility and 15.9 % in the "very low/undetectable" group. By age 32, over 50 % of women have AMH levels categorised as "low fertility" (AMH ≤19.5 pmol/L), increasing to 75 % by age 39. Based on a regression model a decrease in mean AMH of 1.72 pmol/L/year was measured.

We recommend that each ART centre defines their "own" normograms for accurate advice for and treatment of their patients. External laboratory-defined "normal" and "abnormal" AMH levels should be filtered and adapted to the reality of each population. These findings need to be considered when counselling patients and planning treatments as age-specific population normograms can provide a tailored approach.