Objective

目的

To study the association between antimüllerian hormone (AMH) levels and time of pregnancy. Although it has been hypothesized that serum AMH levels may indicate the chance of conception, findings have been mixed. Given that any association is expected to be modest, and it is possible that previous studies have been underpowered, we investigated this relationship in the largest prospective cohort to date.

研究抗米勒管激素（AMH）水平与受孕时间的相关性。尽管有人假设血清AMH水平可以预测受孕的机会，但结果各异。鉴于任何关联预计都是有限的，并且有可能先前的研究由于样本量不足而缺乏足够的说服力，我们对这一相关性进行了迄今为止规模最大的前瞻性队列研究。

Design

设计

Prospective time-to-pregnancy cohort study.

前瞻性受孕时间队列研究。

Setting

场景

Community.

社区。

Patient(s)

患者（们）

A total of 3,150 US women who had been trying to conceive for <3 months and had purchased a Modern Fertility hormone test.

共有3150名美国女性，她们尝试受孕时间少于3个月，并且购买了“现代生育力激素检测”产品。

Intervention(s)

干预措施

We developed a discrete time-to-event model using a binomial complementary log-log error structure within a generalized additive modeling framework, adjusting for confounding factors such as age, body mass index, parity, smoking status, polycystic ovary syndrome, and others. Sensitivity analyses were performed in women with regular menstrual cycles (21–35 days), who did not report using fertility treatments, using alternate AMH level categories (<0.7, 0.7–8.5, >8.5 ng/mL), and AMH levels as a continuous measure.

我们利用广义加性建模框架中的二项式互补对数-对数误差结构，建立一个离散事件发生时间模型，对年龄、体重指数、分娩次数、吸烟状况、多囊卵巢综合征等混杂因素进行了调整。对具有规律月经周期（21至35天）且未报告使用生育治疗手段的女性进行了敏感性分析，分析采用了不同的抗苗勒氏管激素（AMH）水平分类（<0.7、0.7 - 8.5、>8.5 纳克/毫升）以及将AMH水平作为连续测量指标。

Main Outcome Measure(s)

主要结局指标

Primary outcomes included cumulative conception probability within 12 cycles and relative fecundability per menstrual cycle. Conception was defined by a self-reported positive pregnancy test.

主要结局指标包括 12 个周期内的累计受孕率以及每个月经周期的相对生育能力。受孕定义为通过自我报告的阳性妊娠检测结果确定。

Result(s)

结果

Participants contributed 7.21 ± 5.32 cycles, with 1,325 (42.1%) achieving a pregnancy. Women with low AMH levels (<1 ng/mL, n = 427) had a lower chance of natural conception (adjusted hazard ratio [adjHR], 0.77; 95% confidence interval [CI], 0.64–0.94) compared with women with normal AMH levels (1–5.5 ng/mL). There was no difference between high (5.5+ ng/mL) and normal AMH level categories (adjHR, 1.11; 95% CI, 0.94–1.31). The inclusion of AMH improved the model (net reclassification index 0.10 [0.06–0.14]). The instantaneous probability of conception was highest in cycle four across all AMH categories: the probability of natural conception was 11.2% (95% CI, 9.0–14.0) for low AMH levels, 14.3% (95% CI, 12.3–16.5) for normal AMH levels, and 15.7% (95% CI, 12.9–19.0) for high AMH levels. In the regular cycles sensitivity analysis (n = 1,791), the low AMH group had a lower chance of conception (adjHR, 0.77; 95% CI, 0.61–0.97) in the low AMH group compared with normal AMH, and similarly in the continuous model (adjHR, 0.90; 95% CI, 0.85–0.95).

参与者贡献了7.21 ± 5.32个周期，其中1,325名（42.1%）成功怀孕。与AMH水平正常（1-5.5 ng/mL）的女性相比，AMH水平低（<1 ng/mL，n=427）的女性自然受孕的机会较低（调整后的风险比[adjHR]，0.77；95%置信区间[CI]，0.64-0.94）。高AMH（5.5+ ng/mL）与正常AMH两类之间没有差异（adjHR，1.11；95% CI，0.94-1.31）。纳入AMH后改善了这一模型（净重新分类指数0.10 [0.06-0.14]）。在所有AMH类别中，第四周期的即时受孕概率最高：低AMH水平的自然受孕概率为11.2%（95% CI，9.0-14.0），正常AMH为14.3%（95% CI，12.3-16.5），高AMH为15.7%（95% CI，12.9-19.0）。在月经周期规律的敏感性分析中（n=1,791），与正常AMH组相比，低AMH组的受孕机会较低（adjHR，0.77；95% CI，0.61-0.97），连续模型中也类似（adjHR，0.90；95% CI，0.85-0.95）。

Conclusion(s)

结论

Low AMH levels (<1 ng/mL) are independently associated with a modest but significant reduction in the chance of conception.

低AMH水平（<1 ng/mL）是受孕机会适度但显著降低独立相关因素。

参考文献：Antimüllerian hormone levels are associated with time to pregnancy in a cohort study of 3,150 women Nelson, Scott M. et al. Fertility and Sterility, Volume 122, Issue 6, 1114 - 1123

Tags： AMH水平与受孕时间相关性，一项3150名女性的队列研究！