Nomogram for the decline in serum antimullerian hormone: a population study of 9,601 infertility patients

Objective: To define an optimal model for the decline in circulating antimullerian hormone (AMH) with age and develop a validated age-related nomogram. Design: Cohort study with validation of linear, biphasic linear, differential, power, and quadratic equations undertaken in two additional cohorts. Setting: United Kingdom infertility clinics. Patient(s): Training cohort of 4,590 infertile women. Two separate validation cohorts; 4,588 infertile women, and 423 women with confirmed ovulation and normal pelvic ultrasound who have a male partner with severe oligospermia. Intervention(s): Serum AMH measurement. Main Outcome Measure(s): Optimal fit and age-related AMH nomogram. Result(s): The linear model had the largest sum of absolute and squared residuals and provided a less adequate fit than the four nonlinear models. Of these, the R(2) ranged from 19.45% to 19.48% in the training dataset, from 21.30% to 21.36% in the validation dataset, and from 13.29% to 13.75% in the partners of oligospermic males. The parameters of the differential model were difficult to estimate, and the goodness-of-fit of the power model was slightly inferior to the quadratic model. Conclusion(s): Circulating AMH concentrations decline with increasing reproductive age in a manner optimally described by a quadratic equation. This validated age-related AMH nomogram will enable counseling of infertility patients regarding reproductive performance. (Fertil Steril(R) 2011;95:736-41. (C) 2011 by American Society for Reproductive Medicine.)