Antimüllerian hormone levels and numbers and sizes of antral follicles in regularly menstruating women of reproductive age referenced to true ovulation day  Christian Gnoth, M.D., Ph.D., Judith Roos, M.D., David Broomhead, Ph.D., Julia Schiffner, Dipl.-Stat., Erhard Godehardt, Ph.D., Günter Freundl, M.D., Ph.D., Sarah Johnson, Ph.D.  Fertility and Sterility  Volume 104, Issue 6, Pages 1535-1543.e4 (December 2015) DOI: 10.1016/j.fertnstert.2015.08.027 Copyright © 2015 American Society for Reproductive Medicine Terms and Conditions

Figure 1 AMH fluctuations and AFCs by day to true ovulation. Median AMH level with 10th to 90th percentile range and 90th percentiles of the AFC in seven size classes by day relative to objective ovulation for all days with n > 2 samples. The number of circles represents the 90th percentile of the AFC, while their diameter indicates the size class (2–4, 5–7, 8–10, 11–13, 14–16, 17–19, ≥20 mm, represented by size of circle [from smallest to largest]). Fertility and Sterility 2015 104, 1535-1543.e4DOI: (10.1016/j.fertnstert.2015.08.027) Copyright © 2015 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Fluctuations in the level of AMH by day to true ovulation. (A) Periovular decrease. AMH levels for 33 volunteers with basal AMH >1 ng/mL relative to day of ovulation. The regression line (representing average AMH levels over volunteers per day) shows a significant decrease of AMH around ovulation (−5 to +2 days), with a nadir on day +2 of −14.76%. (B) Luteal increase. AMH levels for 33 volunteers with basal AMH >1 ng/mL relative to day of ovulation. The regression line (illustrating average AMH levels over volunteers per day) shows a small, statistically not significant trend to higher mean levels of AMH toward the end of the luteal phase. Fertility and Sterility 2015 104, 1535-1543.e4DOI: (10.1016/j.fertnstert.2015.08.027) Copyright © 2015 American Society for Reproductive Medicine Terms and Conditions

Figure 3 AFCs per size class to AMH levels for cycle days 4–7 (approach 1). (A) AFCs (y-axis) for AMH levels (x-axis) measured on cycle days 4–7 per size class and in total. AMH levels were stratified to different size classes of antral follicles visible with high-resolution ultrasound. Ultrasound measurement of follicles less than 7 mm in diameter is not very precise, therefore, a summarizing class 2–7 mm is included. All antral follicles of all classes were measured on every visit. The regression lines correspond to the coefficients in Supplemental Table 2. The gray bands represent pointwise 95% prediction intervals, which cover the follicle count corresponding to the measured AMH level on cycle days 4–7 with a probability of 95%. (B) Regression lines and prediction intervals for three common coverage probabilities (80%, 90%, 95%). Fertility and Sterility 2015 104, 1535-1543.e4DOI: (10.1016/j.fertnstert.2015.08.027) Copyright © 2015 American Society for Reproductive Medicine Terms and Conditions

Figure 4 AFCs per size class to AMH levels for any preovulatory cycle day ≥4 (approach 2). (A) AFCs (y-axis) for AMH levels (x-axis) measured on any preovulatory cycle day ≥4 per size class and in total. AMH levels were stratified to different size classes of antral follicles visible with high-resolution ultrasound. Ultrasound measurement of follicles less than 7 mm in diameter is not very precise, therefore, a summarizing class 2–7 mm is included. All antral follicles of all classes were measured on every visit. The regression lines correspond to the coefficients in Supplemental Table 3. The gray bands represent pointwise 95% prediction intervals (which, for a future patient, cover the follicle count corresponding to the measured AMH level on any preovulatory cycle day ≥4 with a probability of 95%). (B) Prediction intervals for three common coverage probabilities (80%, 90%, 95%). Owing to the larger variance of the random effects, the prediction intervals for this second model are wider. Fertility and Sterility 2015 104, 1535-1543.e4DOI: (10.1016/j.fertnstert.2015.08.027) Copyright © 2015 American Society for Reproductive Medicine Terms and Conditions