AMH in women with diminished ovarian reserve: potential differences by FMR1 CGG repeat level
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We explored whether AMH, as a surrogate for oocyte supply, varies by FMR1 genotype in women diagnosed with diminished ovarian reserve (DOR), a subset of the Primary Ovarian Insufficiency phenotype. Research is inconsistent on the relationship between AMH and FMR1 repeat length, controlling for age.
Seventy-nine cycling women diagnosed with DOR, and without a family history of fragile X syndrome, provided blood for FMR1 and AMH testing. DOR was defined as elevated FSH and/or low AMH and/or low antral follicle count, with regular menses. FMR1 CGG repeats were stratified by the larger allele <35 repeats (n = 70) v. ≥35 repeats (n = 9). Quadratic and linear models were fit to predict log (AMH) controlling for age. The AMH sample used as the outcome variable was drawn at a later date than the diagnostic AMH.
Serum AMH concentration median was 0.30 ng/mL; Ages ranged from 26–43 years. A quadratic model (including age2) did not show a relationship with FMR1 CGG level (p-value = 0.25). A linear model of log (AMH), corresponding to an exponential decline of AMH with increasing age, was significantly different, and had a steeper slope, for women with ≥ 35 CGG repeats than women with < 35 repeats (p = 0.035).
Findings suggest a greater rate of follicular loss that starts at later ages in women with DOR and ≥ 35 CGG repeats.
KeywordsFMR1 Primary ovarian insufficiency Diminished ovarian reserve Anti-mullerian hormone Ovarian reserve Female infertility Statistical modeling
We thank the participants in this study, the study co-investigators who are not also co-authors (Dr. Lawrence Silverman, University of Virginia; Dr. Joel Finkelstein, Massachusetts General Hospital). All AMH testing was conducted at the Radioimmunoassay Core of the Reproductive Endocrine Sciences Center, Massachusetts General Hospital under the direction of Dr. Patrick Sluss. We are grateful to Carolina Conceptions for allowing recruitment through their clinic in North Carolina. We also thank the clinical research coordinators at all participating clinics: Parchayi Dalal, Hannah Spencer, Amy Brown, Amanda DeSmit, Angie Morey, Rebecca Briggs, and Janetta Phillips. This work was supported by the Eunice K. Shriver National Center for Child Health and Human Development at the National Institutes of Health (grants HD057485, HD052768 and HD068440 to Lisa Pastore). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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