Antimüllerian hormone as a risk factor for miscarriage in naturally conceived pregnancies.

OBJECTIVE

To determine the association between antimüllerian hormone (AMH), a measure of ovarian reserve, and miscarriage among naturally conceived pregnancies.

DESIGN

Prospective cohort study.

SETTING

Not applicable.

PATIENT(S): Women (n = 533), between 30 and 44 years of age with no known history of infertility, polycystic ovarian syndrome, or endometriosis who conceived naturally.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Miscarriage, defined as an intrauterine pregnancy loss before 20 weeks' gestation.

RESULT(S): After adjusting for maternal age, race, history of recurrent miscarriage, and obesity, risk of miscarriage decreased as AMH increased (risk ratio per unit increase in natural log of AMH = 0.83; 95% confidence interval [CI], 0.73, 0.94). Women with severely diminished ovarian reserve (AMH ≤ 0.4 ng/mL) miscarried at over twice the rate of women with an AMH ≥ 1 ng/mL (hazard ratio, 2.3; 95% CI, 1.3, 4.3).

CONCLUSION(S): AMH levels are inversely associated with the risk of miscarriage. Women with severely diminished ovarian reserve are at an increased risk of miscarriage.