Serum AMH concentration has limited prognostic value for the density of primordial follicles questioning AMH as a parameter for the real ovarian reserve

824 female patients (29.5y [23.3; 33.1]) underwent ovarian tissue freezing before gonadotoxic therapy. Follicle density (FD) was performed after digestion of three standardized biopsies per ovary and calcein staining. AMH concentrations were measured before gonadotoxic therapies. First, normograms of FD and AMH in childhood and adulthood were drawn. Second, the adjusted associations between AMH and follicle density were assessed using regression analysis.

Results:

AMH concentrations and follicular density are significantly correlated in women ≥25 y (p = 0.0001) but not in women < 25 y (P = 0.402). The correlation coefficients revealed a moderate relationship in women ≥25 y (r = 0.31) and almost no relationship in women < 25 y (r = 0.05). Modelling the follicle density as a function of both AMH and age the predicted follicle density of women at different ages revealed very large prediction intervals. This highlights the fact that knowing the patient's age and AMH value is not sufficient to reliably predict the follicle density.

Summary:

Serum AMH levels have very limited prognostic value for the real ovarian reserve. Misleading interpretation of serum AMH levels can lead to psychosocial stress and negatively affect family planning.

Furthermore, the analysis of the follicular density opens new perspectives in the transplantation of ovarian tissue as it first allows to identify women with highest chance to succeed and second the amount of tissue needed for transplantation can be defined.