P-646 Prognostic statistical model of age-specific anti-Müllerian hormone (AMH) decrease based on hormone values of 23,528 women
Authors: Vladimirov M , Kalacheva A , Gatev E , Bojilova M , Tacheva D , Kalatchev N , Vladimirov I 
Published: July 2024

Abstract

Study question
The analysis of anti-Müllerian (AMH) levels, can a useful statistical model be constructed to predict the rate of decrease of AMH levels at different ages?

Summary answer
A determination of AMH levels can be an objective marker of a ovarian age and a prognostic marker of the rate of ovarian function decline.

What is known already
The anti-Müllerian hormone is a dimeric glycoprotein produced by granulosa cells of the antral follicles in the ovaries, and AMH participates in the formation of the dominant follicle during folliculogenesis. Serum AMH levels are relatively constant and show little variability between and within the menstrual cycle.
The level of serum AMH is proportional to the number of antral follicles and therefore most suitable for determining ovarian reserve. For this reason, AMH is a convenient marker for the biological age of the ovary and for the response to controlled ovarian stimulation (COS).

Study design, size, duration
A nationwide cross-sectional retrospective study was conducted between 2017 and 2023 and included 23,528 women the ages of 20 - 50, in which AMH levels were measured once. We performed an analysis of the different AMH levels at different ages and constructed a predictive statistical model for the rate of AMH decline. Results were analyzed in subgroups with AMH values &lt; 1 ng/mL, between 1 and 3,5 ng/mL, and &gt; 3,5 ng/mL, at one-year intervals.

Participants/materials, setting, methods
All women who visited the laboratory for AMH testing were included in the analysis. The samples were collected in 38 points throughout the country and the analysis was carried out in one centralized laboratory using the Ansh Labs (Webster, TX, USA) manual assays, including the ultra-sensitive AMH enzyme-linked immunosorbent assay (ELISA), with a management range of 0,08 - 14,2 ng/ml. The intra-assay variations were 1,97% and 4,00%. The inter-assay variations were 4,63% and 1,98%, respectively.

Main results and the role of chance
When analyzing all samples in each consecutive year, we found that the rate of AMH decline was approximately linear and inversely proportional to the woman’s age. However, when analyzing the results for the rate of AMH reduction in the different subgroups, we found out that:
In women with AMH &lt; 1 ng/ml, the rate of decline with advancing age changes as follows: until age 34, the decline in AMH is very slow, between ages 35 and 45 there is a rapid acceleration of the process..
In women with AMH between 1 and 3,5 ng/ml, the rate of decline with age was approximately constant.
In women with AMH &gt; 3,5 ng/ml, the rate of hormone decline is approximately constant but the year-on-year decline rate is decreasing.
Based on our analysis and clinical experience, it is our opinion that the rate of AMH decline for the low AMH group has a non-linear characteristic, while ingeneral different groups exhibit different dynamics for the rate of decline. On this basis, we created a statistical model to predict the decrease in AMH levels at different ages.

Limitations, reasons for caution
Women of only one ethnicity were included in the study. The studied group is heterogeneous, which does not exclude the inclusion of women with a certain pathology and infertility. In some cases, a single determination of AMH could not predict individual differences in rates of hormone reduction.

Wider implications of the findings
Determination of reference values for AMH at different ages, based on the large volume of examined samples may facilitate the application of AMH in clinical practice.
Based on our statistical analysis, creating a prognostic model for decreasing ovarian function and time to menopause appears feasible.

Trial registration number
NA