Markers of Ovarian Reserve

Can we predict the time to menopause in women?
The answer is yes. Today we are analyzing the scientific paper Anti-Mullerian Hormone as a Predictor of Time to Menopause in Late Reproductive Age Women1. This article talks about the Anti-Mullerian hormone (AMH) as a possible measure of reproductive aging. 

The oocyte formation and maturation depend on the endocrine system. There are hormones responsible of the different steps of folliculogenesis. But what is folliculogenesis?

Folliculogenesis is the formation and maturation of the ovarian follicle, where an inmature oocyte is present. 

AMH seems to inhibite recruitment of primordial follicles and decrease the sensitivity of small antral follicles to FSH (Follicule-stimulating hormone), processes necessary for the ovulation. It is present in all the procedure and remains highly expressed in cumulus cells of mature follicles. 

We can conclude that concentration must be lower at older ages. The levels generally become undetectable in the menopause transition. So... the purpose of these researchers was asses if by measuring AMH we could predict the state of the ovarian reserve, better than just focusing on the chronological age. 

A study was done on 401 women over 14 years. All participants were premenopausal, as defined by regular menstrual cycles in the reference range. Ages were between 35 and 48 years. 

AMH hormone was measured by a blood sample... hope you are not afraid of needles... and some risk factors were taken into account: age, race, BMI (Body Mass Index) and current smoker.

The study clearly demonstrated the age-related decline of AMH levels in the late reproductive years but also indicated the considerable variability of age in this decline. This means that is more reliable to take into account the AMH levels than the age, because maybe your ovarian reserve with 35 is as bad as your grandmother's or with 45 is as good as if you were 30. Unfortunately for those mothers that want to make the most of life before pregnancy , the less common is the last case...

In the study, smokers reached menopause earlier compared with nonsmokers. This is due to the toxic effect of smoking that accelerates ovarian follicular depletion. Nevertheless, obesity had no significant association. In the light of this, yeah, maybe is better to eat a portion of pizza tan to smoke a cigarette. 

Evaluation of AMH levels is an excellent tool for women that want to know the number of years before they reach menopause in order to counsel them about their concerns for reproductive planning.

1. Freeman, E. W., Sammel, M. D., Lin, H. & Gracia, C. R. Anti-Mullerian hormone as a predictor of time to menopause in late reproductive age women. J. Clin. Endocrinol. Metab. 97, 1673–1680 (2012).