The modified assay includes a pre-mixing step with a highly anionic buffer which removes this complement. According to the manufacturer, this effect may reflect a possible interaction of complement with the conventional assay resulting in fluctuations due to individual complement activation during storage. Additionally, the AMH levels determined by the modified assay are reported to be higher. Recent studies have suggested that storage conditions led to fluctuations of AMH values determined by this assay, whereas a modified AMH Beckman Coulter Gen II Assay (available since July 2013) resulted in more stable values of AMH independent of storage time and conditions. In the respective study, we used the Beckman Coulter Gen II Assay which was available until July 2013. We concluded that the extremely hypogonadotropic status in pregnancy could be responsible for the decline of AMH during pregnancy, followed by a rapid recovery after delivery.
We have recently observed that AMH decreases during pregnancy, showing the lowest values peripartum, followed by a significant increase of AMH during the first four days after delivery. AMH declines with age but remains stable during the menstrual cycle allowing its determination at random. It is produced by the granulosa cells of small antral and preantral follicles and reflects the size of the pool of these follicles.
Conclusionīy comparing the conventional assay for AMH determination with the modified assay the present study confirmed that AMH levels decline during the course of pregnancy and early after delivery.Īnti-Mullerian Hormone (AMH) is known to be the most precise predictor of ovarian reserve in women. Compared to the longitudinal measurements of AMH levels determined using the conventional assay, AMH levels obtained using the modified assay suggest a steeper decline of values during the course of pregnancy. Measurements with the modified assay showed a significant decline of postpartal levels compared with prepartal levels which is consistent with values obtained using the conventional assay (both p < 0.00001). An overall mean difference of 0.44 ng/ml was observed between the conventional and the modified assay. ResultsĪMH values peripartum were lower than those expected in fertile non-pregnant women of comparable age. The method of Bland and Altman was applied for analyzing the agreement of both methods for determining AMH levels. The Wilcoxon signed rank test was used for determining differences between AMH levels pre- and postpartum. We used the conventional and the modified AMH-Gen-II ELISA (Beckman Coulter, Immunotech, Webster, USA) for the assessment of AMH levels. The conventional and the modified AMH assay were performed in the same patient serum samples.
In another cohort of 11 patients (median age 34.1 years ) blood samples were taken in different trimesters of pregnancy between 19. In this cross-sectional study prepartal blood samples were collected from 62 patients (median age 30.6 years ) in the third trimester of pregnancy and again 1–4 days after delivery between 20. The aim of this study was to evaluate if the decline of AMH levels in the serum of pregnant women during the course of pregnancy and peripartum was assay-dependent and thus artificial. A new Beckman Coulter AMH Gen II assay removes the potentially assay-interfering complement which is activated in pregnancy. AMH levels determined by the conventional AMH assay declined during pregnancy and postpartum.