Biomarkers of low ovarian reserve may not predict fertility as previously thought

Age still remains best predictor of a woman’s reproductive potential.

Biomarkers of low ovarian reserve may not predict fertility as previously thought click to enlarge Anne Steiner, MD, MPH

Media contact: Courtney Mitchell, Courtney.Mitchell@unchealth.unc.edu

October 10, 2017

CHAPEL HILL, N.C. -- A new study led by UNC-Chapel Hill reproductive endocrinologist Anne Steiner, MD, MPH, refutes previously held notions about fertility tests, suggesting that common markers of low ovarian reserve do not predict infertility in women of late-reproductive age.

The results of the study appeared today in the Journal of the American Medical Association.

Ovarian reserve (or the number of remaining oocytes in the female body) has long been evaluated by measuring levels of antimϋllerian hormone (AMH) and follicle stimulating hormone (FSH) found in blood and urine. Low levels of AMH and high levels of FSH point to lower ovarian reserve, or fewer available oocytes, which has been thought to signal infertility in women.

These biomarkers of ovarian reserve are commonly measured in infertile women, and low ovarian reserve has been presumed to be a cause of their infertility. Women and physicians have also started to use these biomarkers as easy and accessible “fertility tests” for women who wish to assess their current fertility. However, results of Steiner’s study of women ages 30-44 did not reveal a relationship between the biomarkers and a woman’s reproductive potential.

“Based on our results, we should caution women from using AMH or FSH levels to assess their fertility.” said Steiner, lead author of the study and professor of obstetrics and gynecology at the UNC School of Medicine. “Low ovarian reserve does not indicate that a woman will necessarily have difficulty conceiving naturally. 

In this cohort study, Steiner and her team measured these biomarkers in women between the ages of 30 and 44 years without a history of infertility, and then followed them while they were trying to get pregnant. As expected, AMH levels decreased and urinary FSH values increased with increased female age. However, after accounting for differences in age, women with a low AMH value (low ovarian reserve) were just as likely to get pregnant within a year of trying compared women with a normal AMH value (normal ovarian reserve).  

Steiner said maternal age is still the main concern when it comes to achieving pregnancy.  

“Age still remains the best predictor of a woman’s reproductive potential,” she said, “Therefore, tests indicating normal or high ovarian reserve should not be used as justification to delay attempts to conceive.”

Steiner is the primary investigator for the UNC-Chapel Hill site of the Reproductive Medicine Network, which runs infertility clinic trials, and sees patients at UNC Fertility in Raleigh, N.C., www.uncfertility.com

For more information about the Department of Obstetrics and Gynecology at the UNC School of Medicine, visit www.med.unc.edu/obgyn.

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