Is Anti-Mullerian Hormone Associated With Fecundability? Findings From the EAGeR Trial

Objective: The objective of the study was to evaluate whether anti-Mullerian hormone (AMH) is associated with fecundability among women with proven fecundity and a history of pregnancy loss. Design: This was a prospective cohort study within a multicenter, block-randomized, double-blind, placebo-controlled clinical trial (clinicaltrials.gov, number NCT00467363). Setting: The study was conducted at four US medical centers (2006-2012). Participants: Participating women were aged 18-40 years, with a history of one to two pregnancy losses who were actively attempting pregnancy. Main Outcome Measures: Time to human chorionic gonadotropin detected and clinical pregnancy were assessed using Cox proportional hazard regression models to estimate fecundability odds ratios (fecundability odds ratios with 95% confidence interval [CI]) adjusted for age, race, body mass index, income, low-dose aspirin treatment, parity, number of previous losses, and time since most recent loss. Analyses examined by preconception AMH levels: low (<1.00 ng/mL, n = 124); normal (referent 1.00-3.5 ng/mL, n = 595); and high (>3.5 ng/mL, n = 483). Results: Of the 1202 women with baseline AMH levels, 82 women with low AMH (66.1%) achieved an human chorionic gonadotropin detected pregnancy, compared with 383 with normal AMH (65.2%) and 315 with high AMH level (65.2%). Low or high AMH levels relative to normal AMH (referent) were not associated with fecundability (low AMH: fecundability odds ratios 1.13, 95% CI 0.85-1.49; high AMH: FOR 1.04, 95% CI 0.87-1.24). Conclusions: Lower and higher AMH values were not associated with fecundability in unassisted conceptions in a cohort of fecund women with a history of one or two prior losses. Our data do not support routine AMH testing for preconception counseling in young, fecund women.