This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Knauff, E. A. H. Search for Related Content PubMed PubMed Citation Articles by Knauff, E. A. H. Pubmed/NCBI databases Substance via MeSH Hazardous Substances DB MENOTROPINS Medline Plus Health Information Premature Ovarian Failure Related Collections Diabetes and Insulin

Anti-Müllerian Hormone, Inhibin B, and Antral Follicle Count in Young Women with Ovarian Failure

Department of Reproductive Medicine and Gynecology (E.A.H.K., M.J.C.E., A.J.G., F.J.M.B., B.C.J.M.F.), University Medical Center, 3584 CX Utrecht, The Netherlands; Department of Public Health (M.J.C.E.), Division of Reproductive Medicine (J.S.E.L.), Department of Obstetrics and Gynecology, and Department of Internal Medicine (A.P.N.T., F.H.d.J.), Erasmus Medical Center, 3000-CB Rotterdam, The Netherlands; Division of Reproductive Medicine (C.B.L.), Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (M.J.K.-B.), Amphia Hospital Langendijk, 4800 RL Breda, The Netherlands; Section of Reproductive Medicine (A.H.), Department of Obstetrics and Gynecology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Obstetrics and Gynecology (C.C.M.B.), University Medical Center St. Radboud, 6500 HB Nijmegen, The Netherlands

Address all correspondence and requests for reprints to: E. A. H. Knauff, M.D., Department of Reproductive Medicine and Gynecology, University Medical Centre, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. E-mail: knauff{at}gmail.com.

Context: Ovarian dysfunction is classically categorized on the basis of cycle history, FSH, and estradiol levels. Novel ovarian markers may provide a more direct insight into follicular quantity in hypergonadotropic women.

Objective: The objective of the study was to investigate the distribution of novel ovarian markers in young hypergonadotropic women as compared with normogonadotropic regularly menstruating women.

Design: This was a nationwide prospective cohort study.

Setting: The study was conducted at 10 hospitals in The Netherlands.

Patients: Women below age 40 yr with regular menses and normal FSH (controls; n = 83), regular menstrual cycles and elevated FSH [incipient ovarian failure (IOF); n = 68]; oligomenorrhea and elevated FSH [referred to as transitional ovarian failure (TOF); n = 79]; or at least 4 months amenorrhea together with FSH levels exceeding 40 IU/liter [premature ovarian failure (POF); n = 112].

Main Outcome Measures: Serum levels of anti-Müllerian hormone (AMH), inhibin B, and antral follicle count (AFC) was measured.

Results: All POF patients showed AMH levels below the fifth percentile (p₅) of normoovulatory women. Normal AMH levels (>p₅) could be identified in 75% of IOF, 33% of TOF patients, and 98% of controls. AFC and AMH levels changed with increasing age (P < 0.0001), whereas inhibin B did not (P = 0.26). AMH levels were significantly different between TOF and IOF over the entire age range, whereas AFC became similar for TOF and IOF at higher ages.

Conclusions: Compared with inhibin B and AFC, AMH was more consistently correlated with the clinical degree of follicle pool depletion in young women presenting with elevated FSH levels. AMH may provide a more accurate assessment of the follicle pool in young hypergonadotropic patients, especially in the clinically challenging subgroups of patients with elevated FSH and regular menses (i.e. IOF) and in hypergonadotropic women with cycle disturbances not fulfilling the POF diagnostic criteria (i.e. TOF).

This article has been cited by other articles:

				A. La Marca, S. Marzotti, A. Brozzetti, G. Stabile, A. C. Artenisio, V. Bini, R. Giordano, A. De Bellis, A. Volpe, A. Falorni, et al. Primary Ovarian Insufficiency due to Steroidogenic Cell Autoimmunity Is Associated with a Preserved Pool of Functioning Follicles J. Clin. Endocrinol. Metab., October 1, 2009; 94(10): 3816 - 3823. [Abstract] [Full Text] [PDF]

				E. A.H. Knauff, L. Franke, M. A. van Es, L. H. van den Berg, Y. T. van der Schouw, J. S.E. Laven, C. B. Lambalk, A. Hoek, A. J. Goverde, S. Christin-Maitre, et al. Genome-wide association study in premature ovarian failure patients suggests ADAMTS19 as a possible candidate gene Hum. Reprod., September 1, 2009; 24(9): 2372 - 2378. [Abstract] [Full Text] [PDF]

				F. J. Broekmans, M. R. Soules, and B. C. Fauser Ovarian Aging: Mechanisms and Clinical Consequences Endocr. Rev., August 1, 2009; 30(5): 465 - 493. [Abstract] [Full Text] [PDF]