Anti-Müllerian Hormone (AMH)
The primary use of AMH testing is to assess a woman’s ovarian reserve status or, in more basic terms, it is an approximation of the supply of eggs a woman has remaining.
Anti-Müllerian Hormone (AMH) is a hormone blood test that is one of several key factors used to help diagnose and treat women experiencing infertility issues. Benefits of AMH testing include: a more direct measurement of ovarian reserve since AMH is produced by developing eggs whereas other tests measure hormones produced by the brain, can be done with blood drawn on any day of the menstrual cycle, and results are not significantly affected by oral contraceptive therapy so patients on oral contraceptives do not have to go off of them.
A key factor in assessing a woman’s reproductive health is her age.
It has been established that a woman has a finite number of eggs and as she ages the quantity and quality of the eggs decreases. Physicians typically use their clinical experience to adjust for the age factor. At Unilab we did not feel it was sufficient to just report a result with normal and abnormal ranges that applied to all women regardless of age.
Therefore, we conducted a study using AMH results from over 2000 infertility patients to develop age-specific mean values that physicians and patients can use to more accurately assess ovarian reserve. For example, a 30 year old may have an AMH of 1.5 which is considered normal, but it should be noted that for this age it is considered low. Conversely, there may be a 40 year old who has an AMH of 1.0 which is considered borderline between normal and low. But, take into consideration her age and this is actually considered on the high end. The main purpose of including age-specific AMH results is to provide physicians and patients with more individualized results for a more individualized diagnosis and treatment.
Anti-Mullerian Hormone (AMH) and Fertility
Up until recently, most of the research into AMH involved women who had already been diagnosed with infertility. It was unclear whether AMH was a good predictor of pregnancy in women who were just starting to attempt pregnancy. A recent study found, however, that in a group of women without infertility, those with a low AMH became pregnant less frequently than those with a higher AMH.
AMH and Fertility Treatment
Women with poor ovarian reserve as evidenced by a low AMH do not respond to fertility medications as well as normal women. These women are known as “poor responders”. Even with the use of aggressive medication protocols using high doses of fertility medications, these women respond poorly, and as a result, have a high rate of treatments which are cancelled for poor or absent response.
Even when eggs are stimulated to develop, the quality ofthose eggs seems poorer. For example, in our IVF program, women with an AMH less than 0.5 do not reach embryo transfer 1/3 of the time. Women with an AMH level over two, however, will have an embryo transfer 99% of the time.
If we look only at women who were able to have an embryo transfer, women with an AMH less than 0.5 had a pregnancy rate of 18% but women with a level over 2.0 had a pregnancy rate of 45%. This argues strongly for abnormality in the eggs of women with poor ovarian reserve.