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Age-specific random day serum antimüllerian hormone reference values for women of reproductive age in the general population: a large Chinese nationwide population-based survey

  • Yongxiu Hao
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Rui Yang
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Jia Li
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Zehong Zhou
    Affiliations
    Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Department of Obstetrics and Gynecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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  • Weiping Qian
    Affiliations
    Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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  • Jian Zhang
    Affiliations
    Department of Pathophysiology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Ze Wu
    Affiliations
    Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
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  • Lei Jin
    Affiliations
    Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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  • Xueqing Wu
    Affiliations
    Reproductive Medicine Center, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Affiliate Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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  • Cuilian Zhang
    Affiliations
    Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, China
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  • Beihong Zheng
    Affiliations
    Reproductive Medicine Center, Fujian Provincial Maternity and Children’s Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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  • Jichun Tan
    Affiliations
    Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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  • Guimin Hao
    Affiliations
    Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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  • Shangwei Li
    Affiliations
    Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
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  • Qin Li
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Danni Zheng
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Yuanyuan Wang
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Rong Li
    Correspondence
    Rong Li, MD, PhD.
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Ping Liu
    Correspondence
    Ping Liu, MD, PhD.
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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  • Jie Qiao
    Correspondence
    Corresponding authors: Jie Qiao, MD, PhD.
    Affiliations
    Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China

    Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China

    Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
    Search for articles by this author
Published:August 03, 2022DOI:https://doi.org/10.1016/j.ajog.2022.07.029

      Background

      Antimüllerian hormone, the most reliable biomarker of ovarian reserve, is widely used in various clinical situations. Antimüllerian hormone levels consistently decrease with age. However, there is no standard, age-specific reference values for antimüllerian hormone in women of reproductive age, which limits its application.

      Objective

      This study aimed to establish age-specific antimüllerian hormone percentile reference values for women of reproductive age.

      Study Design

      A nationwide, population-based cross-sectional survey was conducted between May 2019 and April 2021 in 15 provinces and municipalities in mainland China. A total of 10,053 eligible women aged 20 to 49 years were selected using a multistage stratified sampling procedure. Women who were pregnant, had undergone ovarian surgery, took hormone drugs in the past 3 months, or had an antimüllerian hormone outlier value were excluded from establishing antimüllerian hormone percentile reference values. Serum antimüllerian hormone concentrations were measured using ultrasensitive, 2-site enzyme-linked immunosorbent assays (Ansh Lab, Webster, TX) in the Reproductive Endocrinology Laboratory of Peking University Third Hospital. Generalized additive models for location scale and shape with the Box-Cox t original distribution were used to estimate the fitted antimüllerian hormone percentile reference values.

      Results

      A total of 9112 eligible women aged 21 to 49 years were included in the fitting model. The fitted 50th (2.5th–97.5th) percentiles of antimüllerian hormone values for women aged 21, 25, 30, 35, 40, 45, and 49 years were 4.83 (0.79–18.41), 4.47 (0.72–16.58), 3.67 (0.50–13.82), 2.59 (0.24–10.35), 1.35 (0.05–6.68), 0.33 (<0.01 to 3.40), and 0.04 (<0.01 to 1.77) ng/mL, respectively. The population-based decline rate of antimüllerian hormone accelerated with increasing age, especially age >35 years. The magnitude of the decline of the 25th antimüllerian hormone percentile curve was greater than that of the 75th percentile curve.

      Conclusion

      This study established age-specific antimüllerian hormone percentile reference values for women of reproductive age based on a large representative sample of the general population and described antimüllerian hormone changes. These findings may facilitate antimüllerian hormone application in clinical practices.

      Key words

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