Geographical Diversity in the Age Specific Anti Miillerian Hormone Levels in Infertile Women: A Hospital based Cohort Study.

Background: Serum anti-Mullerian hormone (AMH) is a significant determinant of ovarian reserve. It is still not clear about the rate at which AMH declines with t age and varies across populations. Aim: The present study examined the AMH levels specific to the North and South Indian populations and attempted to establish an age-dependent reference parametrically. Settings and Design: This was a prospective study in a tertiary centre. Materials and Methods: Serum samples were collected apparently from 650 infertile women (327 from North and 323 from South Indians). AMH was measured using an electrochemiluminescent technique. Statistical Analysis Used: Comparison of the AMH data between North and South regions was done by independent t-test. For each age, seven empirical percentiles (3^th, 10^th, 25^th, 50^th, 75^th, 90^th and 95^th) were applied. AMH nomograms for the 3^th, 10^th, 25^th, 50^th, 75^th, 85^th, 90^th and 95^th percentiles were produced using the lambda-mu-sigma method. Results: AMH levels remarkably decreased with increasing age in the North Indian population, but in the South Indian population, they did not decline beyond 1.5 ng/mL. Further, in the North Indian population, AMH levels were significantly higher in the age group of 22-30 years (4.4 ng/mL) than in the South Indian population (2.04 ng/mL). Conclusion: The present study suggests a major geographical difference in mean AMH levels according to their age and ethnic background, regardless of their subjacent pathologies. [ABSTRACT FROM AUTHOR]