Open AccessAge-related nomograms for antral follicle count and anti-Mullerian hormone for subfertile Chinese women in Singapore
Author(s) -
See Ling Loy,
Yin Bun Cheung,
Marielle V. Fortier,
Caroline Ong,
Heng Hao Tan,
Sadhadarajah,
Jerry Kok Yen Chan,
Véronique Viardot-Foucault
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0189830
Subject(s) - anti müllerian hormone , percentile , antral follicle , nomogram , ovarian reserve , medicine , confidence interval , gynecology , population , hormone , infertility , biology , pregnancy , statistics , mathematics , environmental health , genetics
Background Antral follicle count (AFC) and anti-Mullerian hormone (AMH) are known as the most reliable markers of a woman’s ovarian reserve and are related to age. There is currently no specific local age-related centile charts for AFC and AMH. Therefore, we aim to examine the relationship between AFC and AMH with age and construct age-related nomograms among a subfertile Asian population. Methods This is a study involving Chinese women who had their AFC and AMH measured as part of their subfertility screening from December 2010 until November 2014 in KK Women’s and Children’s Hospital, Singapore. Ordinary least squares regression analysis was used to estimate the relationship of AFC and AMH with age, while age-related AFC and AMH nomograms for the 3 rd , 10 th , 25 th , 50 th , 75 th , 90 th and 97 th percentiles were produced using the lambda-mu-sigma method. Results A total of 1,009 women, aged 26 to 44 year-old, were included. On average, the AFC and AMH decreased respectively by 0.79 follicle (95% confidence interval -0.93, -0.64) and 0.38 ng/mL (95% confidence interval -0.43, -0.32) per year of age. The age-related nomograms of AFC showed an approximately linear pattern, inversely correlated with age, regardless of the percentile. For AMH, the pattern is linear for the 75 th percentile and below but shows a slightly accelerating decline for the 90 th and 97 th percentile. Overall, there were large inter-individual variations in AFC and AMH up to about 40 year-old. Conclusion The declines of AFC and AMH over age are mostly linear among subfertile Chinese women in Singapore. The age-related AFC and AMH nomograms could be used as a reference chart by fertility practitioners. However, future validation with longitudinal data is required.