IVF Unit, Department of Obstetrics and Gynaecology, Shaare Zedek MC (affiliated with the Hebrew University School of Medicine) Jerusalem, Israel.
Department of Obstetrics and Gynaecology, Shaare Zedek MC (affiliated with the Hebrew University School of Medicine) Jerusalem, Israel.
Reprod Biomed Online. 2022 Jul;45(1):147-152. doi: 10.1016/j.rbmo.2022.03.005. Epub 2022 Mar 9.
Is extended fertility at the advanced reproductive age of 43-47 years associated with high anti-Müllerian hormone (AMH) concentrations?
Prospective cohort study including 98 women aged 43-47 years old with a spontaneous conception who were tested for AMH concentrations 1-4 days and 3-11 months post-partum. AMH concentrations at 3-11 months post-partum were further compared with AMH concentrations in healthy age-matched controls that last gave birth at ≤42 years old. Women with current use of combined hormonal contraceptives (CHC), ovarian insult or polycystic ovary syndrome were excluded. Power analysis supported the number of participating women.
Median AMH concentrations did not differ between the extended fertility (n = 40) and control (n = 58) groups (0.50 versus 0.45 ng/ml, P = 0.51). This remained when analysing by age (≥ or <45 years old). AMH concentrations and women's age did not correlate within the extended fertility group (r = 0.017, P = 0.92); a weak negative correlation was found within the control group (r = -0.23, P = 0.08). AMH was significantly higher 3-11 months post-partum (0.50 ng/ml [0.21-1.23]) than 1-4 days post-partum (0.18 ng/ml [0.06-0.40]), P < 0.001. The two results for each participant were highly correlated (r = 0.82, P < 0.001). The extended fertility and control groups were similar regarding age, age at menarche, past CHC use and history of fertility concern. Parity differed but showed no significant correlation with AMH.
Serum AMH concentrations that reflect ovarian reserve do not seem to predict reproductive potential at highly advanced age. Thus, additional factors such as oocyte quality should also be considered in evaluating reproductive potential. AMH suppression that is associated with pregnancy at 1-4 days post-partum recovers at 3-11 months post-partum in women of highly advanced reproductive age.
43-47 岁高龄的女性延长生育期是否与高抗苗勒氏管激素（AMH）浓度相关？
前瞻性队列研究纳入 98 名年龄在 43-47 岁之间的自然受孕女性，在产后 1-4 天和 3-11 个月时检测 AMH 浓度。进一步比较产后 3-11 个月的 AMH 浓度与最后一次生育年龄≤42 岁的健康年龄匹配对照组的 AMH 浓度。排除当前使用复方激素避孕药（CHC）、卵巢损伤或多囊卵巢综合征的女性。功效分析支持参与女性的数量。
延长生育期（n=40）和对照组（n=58）的 AMH 浓度中位数无差异（0.50 与 0.45ng/ml，P=0.51）。按年龄（≥或<45 岁）分析也是如此。延长生育期组的 AMH 浓度与女性年龄无相关性（r=0.017，P=0.92）；对照组呈弱负相关（r=-0.23，P=0.08）。产后 3-11 个月时 AMH 显著升高（0.50ng/ml[0.21-1.23]），产后 1-4 天（0.18ng/ml[0.06-0.40]）时降低，P<0.001。每位参与者的两项结果高度相关（r=0.82，P<0.001）。延长生育期组和对照组在年龄、初潮年龄、过去使用 CHC 和生育问题史方面相似。产次不同，但与 AMH 无显著相关性。
反映卵巢储备的血清 AMH 浓度似乎不能预测高龄的生育潜能。因此，在评估生育潜能时，还应考虑卵母细胞质量等其他因素。产后 1-4 天与妊娠相关的 AMH 抑制在高龄产妇中于产后 3-11 个月恢复。
