Antimüllerian hormone levels and antral follicle counts are not reduced compared with community controls in patients with rigorously defined unexplained infertility

Markers of ovarian reserve in patients with unexplained infertility are comparable to those in community controls.

Volume 108, Issue 6, Pages 1070–1077


Eleni A. Greenwood, M.D., M.Sc., Marcelle I. Cedars, M.D., Nanette Santoro, M.D., Esther Eisenberg, M.D., M.P.H., Chia-Ning Kao, M.Sc., Daniel J. Haisenleder, Ph.D., Michael P. Diamond, M.D., Heather G. Huddleston, M.D. for the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network



To test the hypothesis that women with unexplained infertility demonstrate evidence of diminished ovarian reserve when compared with a population of community controls.


Cross-sectional study.


Multicenter university-based clinical practices.


Study participants included 277 healthy, normo-ovulatory female partners with rigorously defined unexplained infertility randomly selected from a multicenter trial (Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation). Controls included 226 healthy, normo-ovulatory women not seeking treatment for fertility from a community-based cohort (Ovarian Aging study).


Serum antimüllerian hormone (AMH) assay at a central laboratory, FSH, fasting serum metabolic testing, transvaginal ultrasonography for antral follicle counts (AFCs), anthropometric measurements.

Main Outcome Measure(s)

Average AMH, AFC, and AMH/AFC were compared between infertile and control women by age. Analyses of covariance compared these outcomes while controlling for confounders, including age, race, body mass index, smoking history, and study site.


In our models, AMH, AFC, and AMH/AFC ovarian reserve indices did not differ between infertile women and community-based controls, after controlling for age, race, body mass index, smoking history, and study site.


Currently utilized predictors of ovarian reserve do not discriminate women with rigorously defined unexplained infertility from healthy community-based women of similar demographic characteristics. Contrary to our hypothesis, among women with FSH in the normal range (≤12 IU/L), women with unexplained infertility did not show evidence of decreased ovarian reserve as measured by AMH and AFC. Ovarian reserve markers in isolation may not serve as predictors of future fertility.

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