Hum. Reprod. Advance Access originally published online on July 30, 2009
Human Reproduction 2009 24(11):2838-2844; doi:10.1093/humrep/dep276
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Anti-Müllerian hormone and inhibin B levels as markers of premature ovarian aging and transition to menopause in type 1 diabetes mellitus
1 Endocrinology and Diabetes Unit, San Borja-Arriarán Hospital, Santiago, Chile 2 Institute of Maternal and Child Research (I.D.I.M.I.), School of Medicine, University of Chile, Casilla, 226-3 Santiago, Chile 3 Universidad de La Frontera, Temuco, Chile 4 University of Talca, Talca, Chile 5 Hospital Regional de Talca, Talca, Chile 6 Centro de Investigaciones Endocrinológicas (CEDIE), Hospital de Niños R. Gutiérrez and Faculty of Medicine, University of Buenos Aires, Argentina
7 Correspondence address. Tel: +56-2-977-0865; Fax: +56-2-424-7240; E-mail: ecodner{at}med.uchile.cl
BACKGROUND: Serum anti-Müllerian hormone (AMH) levels decrease early during the transition to menopause and women with type 1 diabetes mellitus (DM1) experience menopause at a younger age. We hypothesized that older women with DM1 will have lower AMH levels than controls.
METHODS: We studied ovarian function in women with DM1 (n = 66) and healthy controls (n = 58), all <45 years old. Steroids, gonadotrophins, AMH and inhibin B levels were measured during the follicular phase.
RESULTS: Piece-wise regression analysis demonstrated that AMH levels begin to decrease at 33 years of age in both groups. This age limit was used to compare data in both groups. AMH levels were lower in DM1 women than in controls >33 years (4.1 ± 4.2 versus 9.5 ± 7.9 pmol/l, mean ± SD, P = 0.006). A higher proportion of women with DM1 showed AMH levels in the menopausal range compared with controls (16.7% versus 3.4%, respectively, P = 0.02). For all patients, those with DM1 exhibited lower inhibin B levels than controls (89.3 ± 51.7 versus 113.2 ± 76.0 ng/ml, P < 0.05). FSH and estradiol were similar in both groups. Regression analysis showed an earlier decline in AMH levels in women with DM1 than controls. Even after age adjustment, DM1 was a significant factor for the determination of inhibin B and AMH levels.
CONCLUSIONS: Lower AMH levels in women with DM1 during the fourth decade of life suggest the presence of an earlier decline in the ovarian follicle pool in these women. Further studies are needed to evaluate the mechanism of this complication.
Key words: menopause/type 1 diabetes mellitus/anti-Müllerian hormone/inhibin B/ovarian reserve
Submitted on April 14, 2009; resubmitted on June 29, 2009; accepted on July 2, 2009.