Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial

Abstract

Objective To evaluate if anti-Müllerian hormone (AMH) is associated with pregnancy loss. Design A prospective cohort study within a block-randomized, double-blind, placebo-controlled trial of low dose aspirin. Setting Four U.S.A. clinical sites (2006-2012). Patients Women (n=1228) were aged 18-40 years with a history of one to two pregnancy losses and were actively attempting pregnancy without fertility treatment. Interventions None. Main Outcome Measures Pregnancy loss. Results Relative risks (and 95% CI) of hCG detected and clinical pregnancy loss were assessed using log binomial models with robust variance and inverse probability weights adjusted for age, race, BMI, income, trial treatment assignment, parity, number of previous losses, and time since most recent loss. AMH levels were defined as: low (<1.00 ng/mL) (n=124), normal (referent; 1.00 to 3.5 ng/mL) (n=595), and high (>3.5 ng/mL) (n=483). Of the 1202 women with baseline AMH data, 19 (17.3%) women with a low AMH experienced a clinical loss, compared to 61 (11.4%) with normal AMH and 50 (11.8%) with a high AMH level. Low or high AMH levels relative to normal AMH (referent) were not associated with clinical loss (Low AMH: RR, 1.13, 95% CI 0.74, 1.72; High AMH: RR 1.13, 95% CI 0.82, 1.56). Results for hCG detected pregnancy loss mirrored those of clinical loss. Conclusions AMH values were not associated with hCG detected or clinical pregnancy loss in unassisted conceptions in women with a history of one to two prior losses. Our data do not support routine AMH testing for prediction of pregnancy loss.

Antimüllerian hormone as a risk factor for miscarriage in naturally conceived pregnancies

“…In contrast, two other studies have suggested AMH is not associated with a higher rate of miscarriage (19–21). A secondary analysis of the EAGER trial, which included women with at least one prior pregnancy loss attempting to conceive naturally, suggested women with a low AMH value (<1ng/mL) did not have an increased risk of pregnancy loss (19). Thus, it possible, that AMH is not a predictor of recurrent pregnancy loss, as suggested by Zarek at al ., but may play a role in spontaneous loss, as suggested by our cohort.…”

Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age

“…Prior studies to date have failed to show such an association. 25,26 Second, not all women remained in the study for 12 cycles of attempt. This was anticipated, given the older reproductive-age cohort.…”

Pregnancy loss history at first parity and selected adverse pregnancy outcomes

“…In addition, we defined pregnancy loss dichotomously (no loss, at least 1). Cutpoints for gestational age of pregnancy loss(es) were based on the assumed development stage of the conceptus given the time of pregnancy loss recognition, with losses before 6 weeks representing pre-embryologic losses, 6 to 9 weeks representing embryo losses, and ≥10 weeks representing fetal losses [18,19]. Losses before 6 weeks are alternatively defined as “early pregnancy loss” and can represent pre-clinical pregnancy losses [2,20].…”