Association of testosterone and antimüllerian hormone with time to pregnancy and pregnancy loss in fecund women attempting pregnancy

In women without polycystic ovary syndrome or infertility, the combination of higher total T and antimullerian hormone was associated with greater sporadic anovulation but with mild effects on time to pregnancy and pregnancy loss.

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Volume 109, Issue 3, Pages 540–548.e1

Authors:

Lindsey A. Sjaarda, Ph.D., Sunni L. Mumford, Ph.D., Daniel L. Kuhr, B.S., Tiffany L. Holland, B.A., Robert M. Silver, M.D., Torie C. Plowden, M.D., Neil J. Perkins, Ph.D., Enrique F. Schisterman, Ph.D.

Abstract:

Objective

To examine whether higher T and/or antimüllerian hormone (AMH) was associated with anovulation, time to pregnancy (TTP), or pregnancy loss risk among healthy, fecund women without diagnosed polycystic ovary syndrome.

Design

Prospective cohort study conducted as a secondary analysis from the Effects of Aspirin in Gestation and Reproduction randomized trial.

Setting

University medical centers.

Patient(s)

A total of 1,198 healthy, eumenorrheic women aged 18–40 years attempting spontaneous pregnancy with one to two prior pregnancy losses were included. Women were categorized by baseline antimüllerian hormone (AMH), as a surrogate marker of antral follicle count, and T concentrations; the highest quartile for each was “high,” and below the top quartile (i.e., lower 75% of values) was “norm,” forming four groups: norm T/norm AMH (n = 742), norm T/high AMH (n = 156), high T/norm AMH (n = 157), and high T/high AMH (n = 143).

Intervention(s)

Not applicable.

Main Outcome Measure(s)

Anovulation, pregnancy incidence, TTP, and pregnancy loss incidence.

Result(s)

Women with high T/high AMH had a greater anovulation risk (risk ratio 1.58, 95% confidence interval 1.13–2.22) compared with women with norm T/norm AMH, but with imprecise differences in incidence of pregnancy, TTP, or pregnancy loss.

Conclusion(s)

Women with higher T and AMH had more frequent anovulatory cycles but with marginal impacts on TTP or pregnancy loss. A continuum of mild inefficiency in reproductive function may be related to higher T and AMH, including in fecund women with normal menstrual cycles and no clinical diagnosis of polycystic ovary syndrome, but with unclear effects on fecundability and pregnancy loss.

Clinical Trial Registration Number

NCT00467363.



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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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