A Pilot Study for Exploring Blood Spot Anti-mullerian Hormone for Population-based Adolescent Reproductive Health Research

Overview

Journal Front Womens Health

Publisher Open Access Text

Date 2021 Sep 17

PMID 34532593

Authors

Kelli S Hall

Shelby T Rentmeester

Yuan Zhao

Allison N Hankus

Yidan Pei

Halley Em Riley

Candace McCloud

Bradley D Pearce

Affiliations

Soon will be listed here.

Abstract

Introduction And Objective: Studies of Anti-Müllerian Hormone (AMH) rely upon serum measures and clinical samples of older reproductive-aged women intended/attempting pregnancy, with known fertility issues or medical morbidities. We explored the utility of minimally invasive AMH as a measure of fecundability in population-based reproductive health research.

Methods: We analyzed baseline data from 191 participants in a pilot, longitudinal cohort study, the Young Women's Stress Study. Using an integrated biosocial design, we collected interviewer-administered surveys on demographic, psychosocial, health, and method feasibility/acceptability information and finger-stick capillary dried blood spots (DBS). We used descriptive and bivariate statistics (correlation, T-tests, ANOVA) to estimate method feasibility/acceptability and unadjusted AMH mean concentrations overall and across sociodemographic, reproductive, and health covariates.

Results: AMH concentrations ranged from 1.02 to 22.23 ng/mL, with a mean of 5.66 ng/mL. AMH concentrations were associated with current hormonal contraceptive use, menstrual cycle frequency, and irregular menstrual patterns, but not with other known correlates. Most participants stated the DBS method was comfortable (81%) and would be likely to provide it again (88%).

Conclusions: While these pilot data suggest AMH fell within normal range and our DBS methods were acceptable/feasible, the broader question of its usefulness for population reproductive health research remains unanswered. Larger, longitudinal studies are needed to validate AMH against time-to-pregnancy and gold standard measures in young healthy samples and across different sociodemographic groups. Public health and social scientists should consider the resource costs of AMH, ethical issues, and risks of (over)interpretation, with a reproductive justice and human rights frame in mind.

References

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Barber J, Kusunoki Y, Gatny H . Design and implementation of an online weekly journal to study unintended pregnancies. Vienna Yearb Popul Res. 2012; 9:327-334. PMC: 3298188. DOI: 10.1553/populationyearbook2011s327. View

Dewailly D, Andersen C, Balen A, Broekmans F, Dilaver N, Fanchin R . The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update. 2014; 20(3):370-85. DOI: 10.1093/humupd/dmt062. View

Su X, Carlson B, Wang X, Li X, Zhang Y, Montgomery J . Dried blood spots: An evaluation of utility in the field. J Infect Public Health. 2017; 11(3):373-376. PMC: 5874153. DOI: 10.1016/j.jiph.2017.09.014. View

Fleming R, Seifer D, Frattarelli J, Ruman J . Assessing ovarian response: antral follicle count versus anti-Müllerian hormone. Reprod Biomed Online. 2015; 31(4):486-96. DOI: 10.1016/j.rbmo.2015.06.015. View

Ben-Shlomo Y, Kuh D . A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol. 2002; 31(2):285-93. View

Cohen S, Kamarck T, Mermelstein R . A global measure of perceived stress. J Health Soc Behav. 1983; 24(4):385-96. View

Steiner A, Pritchard D, Stanczyk F, Kesner J, Meadows J, Herring A . Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. 2017; 318(14):1367-1376. PMC: 5744252. DOI: 10.1001/jama.2017.14588. View

Hall K, Kusunoki Y, Gatny H, Barber J . The risk of unintended pregnancy among young women with mental health symptoms. Soc Sci Med. 2014; 100:62-71. PMC: 3898511. DOI: 10.1016/j.socscimed.2013.10.037. View

10.

Hagen C, Aksglaede L, Sorensen K, Mouritsen A, Andersson A, Petersen J . Individual serum levels of anti-Müllerian hormone in healthy girls persist through childhood and adolescence: a longitudinal cohort study. Hum Reprod. 2012; 27(3):861-6. DOI: 10.1093/humrep/der435. View

11.

Moos M, Dunlop A, Jack B, Nelson L, Coonrod D, Long R . Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol. 2008; 199(6 Suppl 2):S280-9. DOI: 10.1016/j.ajog.2008.08.060. View

12.

Elchuri S, Patterson B, Brown M, Buchanan I, Mertens A, Meacham L . Anti-Mullerian hormone levels in American girls by age and race/ethnicity. J Pediatr Endocrinol Metab. 2014; 28(1-2):189-93. DOI: 10.1515/jpem-2014-0242. View

13.

Harris P, Taylor R, Minor B, Elliott V, Fernandez M, ONeal L . The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95:103208. PMC: 7254481. DOI: 10.1016/j.jbi.2019.103208. View

14.

Finer L, Henshaw S . Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006; 38(2):90-6. DOI: 10.1363/psrh.38.090.06. View

15.

Amer S, James C, Al-Hussaini T, Mohamed A . Assessment of Circulating Anti-Müllerian Hormone in Women Using Hormonal Contraception: A Systematic Review. J Womens Health (Larchmt). 2019; 29(1):100-110. DOI: 10.1089/jwh.2019.7733. View

16.

Hagen C, Aksglaede L, Sorensen K, Main K, Boas M, Cleemann L . Serum levels of anti-Müllerian hormone as a marker of ovarian function in 926 healthy females from birth to adulthood and in 172 Turner syndrome patients. J Clin Endocrinol Metab. 2010; 95(11):5003-10. DOI: 10.1210/jc.2010-0930. View

17.

Broer S, Broekmans F, Laven J, Fauser B . Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications. Hum Reprod Update. 2014; 20(5):688-701. DOI: 10.1093/humupd/dmu020. View

18.

Diez Roux A . Integrating social and biologic factors in health research: a systems view. Ann Epidemiol. 2007; 17(7):569-74. DOI: 10.1016/j.annepidem.2007.03.001. View

19.

Harris K, Schorpp K . Integrating Biomarkers in Social Stratification and Health Research. Annu Rev Sociol. 2019; 44:361-386. PMC: 6433161. DOI: 10.1146/annurev-soc-060116-053339. View

20.

Harris K, McDade T . The Biosocial Approach to Human Development, Behavior, and Health Across the Life Course. RSF. 2019; 4(4):2-26. PMC: 6434524. DOI: 10.7758/RSF.2018.4.4.01. View