Variations and Age-Specific Reference Ranges of Anti-Mülerian Hormone in Healthy Chinese Women of Reproductive and Perimenopausal Age: a Prospective Nationwide-population based Prospective Cross-sectional Study

Categories: Reproductive medicine/assisted reproduction

Linli Hu¹, Yunshan Zhang^2*, Qiongfang Wu^3*, Xiaoyan Liang^4*, Xiaohong Wang^5*, Cunying Pu⁶, and Yingpu Sun¹

¹ Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;

² Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China;

³ Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, China,;

⁴ Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

⁵ Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, China;

⁶ Medical and Scientific Affairs, Roche Diagnostics (Shanghai) Co., Ltd., Shanghai, China

^* These authors contributed equally to this study;

First author: Linli Hu, Corresponding author: Yingpu Sun

BACKGROUND

What is known already:

1. AMH is a dimeric glycoprotein that undergoes initial follicular recruitment. As a crucial biomarker evaluating
ovarian reserve functions [1], serum AMH has been actively measured to predict the response to ovarian
stimulation and pregnancy outcomes of in vitro fertilization (IVF)[2-4].

2. Previous studies showed that age and ethnicity could independently affect the variation of serum AMH levels:
AMH in adult Chinese women was substantially lower than that in their European counterparts from age 25
onwards [5].

3. AMH could rapidly decrees at the end of fertility (40 50 years) and become undetectable approximately five
years before the final menstrual period [6], endowing its potential to evaluate perimenopause fertility and also
aid in the understanding of fertility transition during perimenopause [7].

Objective:

1. To establish age specific AMH reference ranges for Chinese women of r eproductive and p erimenopausal age.

2. To investigate the variation of AMH during the fast fertility declining ages >40 years.

METHODS

1. This prospective cross-sectional multicenter study was started in May 2022 and finished in February 2023.

2. This study was designed to enroll ≥1080 subjects (20-49 years) from five reproductive centers: central, eastern, western, northern, and southern, with ≥ 480 subjects of reproductive age (20-39 years) and ≥ 600 in perimenopause (40-49 years) ), and the two age groups are composed of 4 and 5 subgroups (n ≥120) with an interval of 2 and 5 years, respectively.