Study: Ovarian reserve biomarkers not associated with fertility
According to a prospective study published online in JAMA, biomarkers used to estimate ovarian reserve are not linked to fertility in women aged 30 to 44 years who have no history of infertility and have tried to conceive for 3 months or less. The findings call into question the use of serum and urinary follicle-stimulating hormone (FSH) tests or antimüllerian hormone (AMH) levels to assess natural fertility levels in these women.
The researchers examined the association of early-follicular-phase serum AMH, serum FSH, serum inhibin B, and urinary FSH with reproductive potential as measured by the probability of conceiving naturally. Using a prospective time-to-pregnancy model, between 2008 and 2016, 750 women were enrolled in the study and provided a blood and urine sample. The researchers adjusted for age, body mass index, race, current smoking status, and hormonal contraceptive use. Subgroup analyses were also conducted using age and parity.
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The researchers found no association between low AMH (0.7 ng/mL) or high FSH (> 10mIU/mL) and reduced fecundability or decreased cumulative probability of conceiving with 6 or 12 cycles of attempting pregnancy. Among women with low AMH numbers, the probability of conceiving by 6 cycles of attempt was 65% vs. 62% among women with normal values. No difference was found between the groups after 12 cycles either (84% vs. 75%, respectively). Women with high serum FSH did not have a significant difference in predicted probability of conceiving after 6 cycles of attempt compared with women who had normal values (63% vs 62%, respectively) or after 12 cycles (82% vs. 75%, respectively). Women with high urinary FSH values (> 11.5mlU/mg creatine) did not have significantly different predicted probability of conceiving after 6 cycles (61% vs 62% for women with normal values) or after 12 cycles (70% vs. 76% for women with normal values).
The researchers concluded that because their findings do not support an association between biomarkers and fertility, clinicians should not use urinary or blood follicle-stimulating tests or antimüllerian hormone levels to predict natural infertility in healthy women without a history of infertility. However, they noted several limitations to the study. Because the only pregnancy outcome available was a positive pregnancy test, it is possible that more pregnancy losses and lower live birth rates occurred among women with low ovarian reserve. Women with known fertility problems or who had partners affected by fertility problems were excluded from the study, so more research is necessary to determine the effectiveness of biomarker prediction in this population.