ESPE Abstracts

Introduction and Objective: Puberty marks the transition from childhood to adulthood, initiated by the activation of the hypothalamic-pituitary-gonadal axis. Anti-Müllerian hormone (AMH) and inhibin B, both secreted by granulosa cells, play crucial roles in pubertal development and reflecting ovarian reserve. Establishing reference intervals for AMH and inhibin B across different pubertal stages is essential for assessing ovarian function and identifying potential reproductive health issues early. This study aims to establish these reference intervals, reflecting ovarian reserve in children and adolescent girls.

Method: This prospective, single-center study included 320 healthy females aged between 6-18 years who attended the General Pediatric Clinic of Cerrahpaşa Medical Faculty between 2023-2024. Blood samples were collected to measure luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), inhibin B, and anti-Müllerian hormone (AMH) levels. Antral follicle counts were performed on patients using transabdominal ultrasound. Exclusion criteria included recent acute and chronic illness, medication use within 2 weeks, hormonal treatments, history of ovarian surgery, metabolic diseases like galactosemia, syndromic conditions such as Turner syndrome, and history of chemotherapy or radiotherapy, ensuring a healthy cohort for accurate AMH and inhibin B reference interval determination.

Results: The mean age of the participants was 11.7 ± 3.2 years, with 66/320 (20.5%) being postmenarcheal. The mean AMH level was 2.68 ± 1.56 ng/mL and 58 girls (18%) had AMH values below 1.5ng/mL. Although AMH levels varied with age, this variation was not statistically significant. Reference intervals (RIs) for AMH and Inhibin B levels were calculated for each age and pubertal group. When compared according to pubertal stages, the highest average AMH value was found in stage 5 (3.37±1.75). Menstrual status did not significantly impact AMH concentrations (P = 0.36). Also, when comparing patients pre and postmenarcheal, significant differences were found in terms of Inhibin B (36.3±42.9pg/ml, p:0.01), FSH (4.1±2.4mIU/mL, p:0.01), LH (4.7± 6.2 mIU/mL, and E2 (44.8± 64.3pg/ml, p:0.001) levels.

Conclusion: This study established reference intervals (normograms) for Anti-Müllerian hormone and inhibin B across different pubertal stages in healthy female participants. The normograms for AMH and inhibin B provide valuable tools for assessing pubertal status and ovarian reserve in clinical practice. These reference intervals can facilitate the early diagnosis and management of ovarian insufficiency, allowing for timely fertility preservation and improved long-term reproductive health outcomes. This advancement addresses the previously undefined threshold values for the pediatric population, enhancing our ability to monitor and support reproductive health from a young age.