Page 18 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 1
In women, AMH levels are highest during early adulthood. After that, just like the number of ovarian follicles, AMH levels decline over age, until serum AMH is undetectable around menopause.18
Currently, serum AMH levels are the most reliable predictor for the age at which a woman will enter menopause.40 Where other hormonal markers for ovarian function, such as follicle stimulating hormone (FSH), might vary throughout the menstrual cycle, serum AMH concentrations are fairly stable throughout the menstrual cycle phases.41 Over the years, a variety of AMH assays have been developed, but large comparison studies of the different assays are lacking.42,43 More recently ultra- sensitive assays have been introduced, which are able to measure serum AMH levels below the previous limits of detection.44
In pregnant women, lower serum AMH levels have been reported, with the lowest levels measured during the third trimester of pregnancy.45-48 The effect of oral contraceptives use on AMH levels has been studied, but results are inconclusive, with several studies reporting no effect of hormonal contraceptives on serum AMH levels49-51, and others nding decreased AMH levels in users of hormonal contraceptives.52-54
Regarding fertility, AMH levels have been reported to add to the prediction of live birth in assisted reproductive technology cycles55-59, and low serum AMH levels have been reported to be associated with a reduced chance of natural conception60, although results are not very consistent.61
Subfertility
In the majority of the general population, a pregnancy is achieved within one year of actively trying to conceive. However, for 10 to 15 percent of the couples having regular unprotected intercourse aiming at achieving a pregnancy, this goal is not met within 12 months and they are considered subfertile.62
Several factors can compromise a couple’s fertility. In the male partner, subfertility is often caused by a reduced sperm count (oligospermia), or absence of spermatozoa in the ejaculate (azoospermia). Causes can be pretesticular, testicular, and post- testicular. Pretesticular disorders are mainly endocrine disorders.63,64 Testicular disorders, also known as primary testicular dysfunction, include congenital and genetic disorders, gonadotoxins including certain medication, and damage resulting from infection or trauma. Posttesticular causes include ejaculatory dysfunction, such as retrograde ejaculation, and obstructions of the reproductive tract.
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