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Submitted on February 13, 2006
Accepted on June 16, 2006
Department of Gynaecology, Academic Medical Centre, Amsterdam, Department of Public health, Erasmus Medical Centre, Rotterdam, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, all in the Netherlands
* To whom correspondence should be addressed. E-mail: f.broekmans{at}umcutrecht.nl.
Context: Anti Müllerian Hormone (AMH), a quantitative marker for ovarian reserve, has been suggested to be independent of the classical endocrine fluctuations of the menstrual cycle.
Objective: To determine if AMH levels are constant throughout the menstrual cycle compared with those of follicle stimulating hormone (FSH), LH (LH) and estradiol.
Design/patients: Frequent blood sampling was performed in 44 fertile, regularly cycling, female volunteers during one full menstrual cycle.
Setting: University hospital.
Main outcome measures: AMH, FSH, LH and estradiol measurements were allocated to one of seven cycle phases and a multilevel analysis was performed. Consistent fluctuation patterns were tested by fitting sine patterns to the data. Finally, the frequency in which randomly selected individual samples would remain in one of five preset level categories (quintiles) for each of the variables was studied.
Results: A sine pattern fitted to the AMH data were not statistically significant (P = 0.40). In contrast sine patterns for FSH, LH and estradiol were highly significant. Comparing the seven cycle phases, no significant differences could be observed between phase specific AMH levels (P = 0.06). Repeated selection of AMH samples for each individual showed that in 71.5% of selections AMH values remained in the same quintile, while in 27.9% values fell in an adjacent quintile.
Conclusions: AMH levels measured through a full menstrual cycle did not show consistent fluctuation patterns in contrast to levels of FSH, LH and estradiol. Furthermore random fluctuations were small, indicating that AMH can be relied upon as a cycle independent marker for ovarian reserve.
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