Nomogram for the Decline in Serum Antimüllerian Hormone: a Population Study of 9,601 Infertility Patients

Objective: To define an optimal model for the decline in circulating antimüllerian 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.