Naasan M N, Harrity C, Pentony L, Mocanu E
Human Assisted Reproduction Ireland (HARI) Unit, Rotunda Hospital, Parnell Square, Dublin 1, Ireland,
Ir J Med Sci. 2015 Mar;184(1):213-8. doi: 10.1007/s11845-014-1089-0. Epub 2014 Feb 23.
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.
抗苗勒管激素（AMH）作为评估卵巢储备的生物标志物备受关注，关于其作为辅助生殖技术（ART）结局预测指标的应用也存在争议。正常水平尚未明确界定，基于年龄的参考范围可能有助于为患者提供咨询。
确定不育女性的AMH水平，确定特定年龄的百分位数及与年龄相关的下降情况，创建用于ART前患者咨询的人群正态图。
在一家三级学术辅助生殖中心进行回顾性研究，分析2009年1月至2011年12月期间因不育前来检查的女性患者的AMH水平（n = 3058）。
很少有患者的AMH水平处于外部实验室预先定义的“正常生育潜力”范围内。只有8.1%的患者具有“最佳生育能力”，18.6%的患者“满意”，54.6%的患者生育能力“低”，15.9%的患者处于“极低/不可检测”组。到32岁时，超过50%的女性AMH水平被归类为“低生育能力”（AMH≤19.5 pmol/L），到39岁时这一比例增至75%。基于回归模型，测得平均AMH每年下降1.72 pmol/L。
我们建议每个ART中心为其患者的准确咨询和治疗定义自己的“正态图”。应筛选并根据每个群体的实际情况调整外部实验室定义的“正常”和“异常”AMH水平。在为患者提供咨询和规划治疗时应考虑这些发现，因为特定年龄的人群正态图可以提供量身定制方案。
