Peripubertal changes in circulating antimüllerian hormone levels in girls

Abstract

ObjectiveTo identify correlates and longitudinal changes in circulating antimüllerian hormone (AMH) levels as a marker of ovarian primordial follicle recruitment in normal peripubertal girls.DesignObservational study using mixed longitudinal and cross-sectional analyses.SettingNot applicable.Patient(s)Unselected girls assessed at ages 7–11 years.Intervention(s)None.Main Outcome Measure(s)AMH, inhibin B, and FSH levels were analyzed in blood samples collected at ages 7, 9, and 11 years for longitudinal analyses and at age 8 years for cross-sectional analyses.Result(s)In the cross-sectional analysis, AMH levels at age 8 years were lower in pubertal girls (median 25.0 pmol/L, interquartile range [IQR] 16.0–33.9; n = 39) than in prepubertal girls (33.5 pmol/L, IQR 22.3–49.1; n = 342). In prepubertal girls, higher AMH levels were associated with higher inhibin B levels, lower FSH levels, and larger body mass index at age 8 years and subsequently with later age at menarche. AMH levels were unrelated to birth weight or birth length. In the longitudinal analysis, AMH levels increased between ages 7 (median 27.0 pmol/L, IQR 19.2–34) and 9 years (32.0 pmol/L, IQR 26.5–42.7), then declined between 9 and 11 years (26.5 pmol/L, IQR 19–42.25) with high intraindividual correlation in AMH levels between ages 7 and 9 years and 7 and 11 years.Conclusion(s)Measurement of circulating AMH and inhibin B levels suggests that the rate of ovarian primordial follicle recruitment increases in the prepubertal years then declines again following the onset of puberty as follicular activity pattern changes.

Anti-Müllerian hormone in children: a ten-year prospective longitudinal study (EarlyBird 39)

“…Our findings of stable AMH levels in females during childhood and early adolescence, their inverse association with FSH before puberty, and loss of the inverse correlation between AMH and both LH and FSH at the onset of puberty are consistent with those of other studies (20,23,24,29). Collectively, these data, combined with known early follicular recruitment dynamics and its association with AMH across the life-course (31), suggest that the pituitary-gonadal axis may be partially active during childhood.…”

“…Second, we do not have testosterone measurements, and although AMH is known to be negatively associated with testosterone from the time of puberty and in adulthood, whether this is causal remains unknown (22,23). Third, we also lacked inhibin B measurements in the girls, which would have allowed us to examine the recently reported divergence with AMH (24). In girls, analysis of AMH levels in relation to oestradiol and inhibin B levels would provide a fuller understanding of changes in the rate of ovarian follicle recruitment and follicle activity.…”

“…They described stable AMH levels and weak inverse correlations with FSH. Lashen et al (24) reported a pilot longitudinal study of 32 girls measured thrice from 7 years onwards, who appeared to show a small prepubertal peak in AMH and similar inverse correlations with FSH.…”

Biomarkers of ovarian reserve in childhood and adolescence: A systematic review

“…Six cross‐sectional studies used cross‐sectional data to report the mean/median serum AMH with the reference ranges (SD/10th‐90th/5‐95th/2.5‐97.5th centile) from birth into adult life . Six studies reported this data in a longitudinal study design . All studies show a consistent pattern of an increase in AMH in childhood, a slight decrease at puberty followed by constant levels throughout adolescence.…”

“…Mean, Childhood: Lee, Cui, Savas‐Erdeve, Sahin and Korkmaz . Median, Adolescence: Lee, Lashen, Anderson, Pinola, Elchuri, Cui, Hart, Hernandez and Yetim . Mean, Adolescence: Lee, Elchuri, Cui, Akin, Kim, Reinehr and Sophor…”