Over the past year, studies have emerged, and our own experience has confirmed, that anti-Müllerian hormone (AMH) testing is the best and most accurate predictor of a woman’s remaining ovarian reserve (the number of eggs remaining in the ovaries). As a result, the anti-Müllerian hormone test has become a standard of care at Shady Grove Fertility and a standard test used to determine a woman's fertility.
Currently, there are several studies on AMH that are advancing our knowledge of its role in fertility. Some specific areas of research include: investigating AMH and its effects on ovarian responsiveness, using AMH in predicting treatment success, and correlating AMH levels in predicting the occurrence of menopause.
AMH & what it reveals about a woman’s fertility
What is AMH?
Anti-Müllerian hormone (AMH) is a hormone produced by the small immature follicles within the ovary. The AMH level is indicative of the size of the pool of follicles that remain. Therefore, in conditions where there are many immature follicles, the AMH level is high. As a woman grows older, and the pool of eggs decreases, the AMH level declines. Therefore, by the time a woman reaches menopause, AMH is undetectable.
How will be physician test my AMH level?
Your physician will measure your AMH level using a simple blood test. The level of AMH is fairly constant throughout a woman’s menstrual cycle; therefore, a big advantage of AMH is that your physician can measure it anytime during your cycle.
What does my AMH level reveal?
AMH blood levels are thought to reflect the size of the remaining egg supply; therefore, AMH is an early and reliable detector of ovarian function and your physician will use it to help predict how you will respond to fertility treatments or if egg freezing is a viable option.
AMH is usually the earliest indicator of a diminished ovarian reserve and reduced AMH levels can indicate a problem before an increase in baseline FSH is seen. Since AMH is one of the better predictors of ovarian reserve, physicians also use it to determine if egg freezing is a viable option. Your physician may order an AMH test in conjunction with FSH, estradiol, and an antral follicle count to give a more comprehensive evaluation of the quantity of your remaining eggs.
How do the results of my AMH level impact treatment?
Your physician will use AMH to evaluate not only a potential low response to stimulation medication, as is seen in patients with a decreased ovarian reserve, but also a possible over-response. AMH is a better predictor of an excessive response than a woman’s age, body mass index, or FSH level. Should a patient have a known high AMH level, the physician will tailor the stimulation protocol accordingly to allow for the best outcomes.
Can I test my AMH if I am on a contraceptive?
In a recent study, researchers found that women using continuous combined contraceptives, regardless of the route of administration (oral contraceptive pills, skin patches, or vaginal), had significantly lower AMH levels. Therefore, we would schedule this test on day 3 of your menstrual cycle and monitor which birth control you are taking, as some have a stronger impact on the AMH level than others.
What medical conditions affect an AMH level?
Women with polycystic ovary syndrome (PCOS) have a higher number of early antral follicles resulting in higher baseline AMH levels. Your physician may correlate your AMH levels to PCOS severity, as AMH tends to be higher in women with insulin-resistant PCOS.
Where can I have my AMH tested?
Your primary care physician, OB/GYN, or reproductive endocrinologist can order AMH testing as part of egg freezing testing. Due to AMH’s ability to identify a diminished ovarian reserve—even better than FSH—test results can give providers information earlier regarding a potentially serious fertility problem.