Geographical Diversity in the Age Specific Anti Müllerian Hormone Levels in Infertile Women: A Hospital based Cohort Study.

BACKGROUND: Serum anti-Mullerian hormone (AMH) is a significant determinant of ovarian reserve. It is still not clear about the rate at which AMH declines with age and varies across populations.

AIM: The present study examined the AMH levels specific to the North and South Indian populations and attempted to establish an age-dependent reference parametrically.

SETTINGS AND DESIGN: This was a prospective study in a tertiary centre.

MATERIALS AND METHODS: Serum samples were collected apparently from 650 infertile women (327 from North and 323 from South Indians). AMH was measured using an electrochemiluminescent technique.

STATISTICAL ANALYSIS USED: Comparison of the AMH data between North and South regions was done by independent t -test. For each age, seven empirical percentiles (3rd , 10th , 25th , 50th , 75th , 90th and 95th ) were applied. AMH nomograms for the 3rd , 10th , 25th , 50th , 75th , 85th , 90th and 95th percentiles were produced using the lambda-mu-sigma method.

RESULTS: AMH levels remarkably decreased with increasing age in the North Indian population, but in the South Indian population, they did not decline beyond 1.5 ng/mL. Further, in the North Indian population, AMH levels were significantly higher in the age group of 22-30 years (4.4 ng/mL) than in the South Indian population (2.04 ng/mL).

CONCLUSION: The present study suggests a major geographical difference in mean AMH levels according to their age and ethnic background, regardless of their subjacent pathologies.