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What is Anti Müllerian Hormone AMH?

Anti Müllerian Hormone also known as AMH is a hormone produced by growing follicles (antral and pre-antral) in the woman. Follicles are the structure that contain the woman’s eggs(each follicle is a sac of fluid that contains one egg). The more follicles present within the ovary, the higher the AMH levels.

Why is AMH testing performed?

AMH has traditionally been used to measure the woman’s ovarian reserve and has become a gold standard in fertility testing prior to fertility treatment. New research however, indicates that AMH testing may not be as accurate as previously thought and many experts question the reliability of the test. AMH levels should be used with caution and the results should be interpreted as such. The journal of Fertility and Sterility stated that hormone testing such as AMH, Estradiol, FSH and inhibin B testing “are only poor to fair measures of how a woman’s ovaries will respond to stimulation or her ability to conceive”.

The AMH testing in the past has been a tool that many fertility physician’s use to measure a woman’s remaining fertility with advanced age. This test is typically performed prior to IVF treatment when considering if the woman is a good candidate or will have a good response to IVF treatment. Since IVF can be costly,  many women may opt to forgo IVF treatment if their AMH level is low however AMH testing is not an absolute predictor of success and many women with a low AMH level have still been able to conceive following in-vitro fertilization.  AMH testing is often ordered along with FSH, estradiol testing. The results of this test may or may not be clinically significant in predicting ovarian reserve and if the woman will respond favorably to IVF treatment or not.

Women with polycystic ovarian syndrome( PCOS )may have very elevated AMH level and many physicians will use this test in ruling out a diagnosis of PCOS. It may also be used as a marker for certain types of ovarian cancer that can cause an increase in the AMH level.

In addition, the AMH level is also used to predict menopause as the level will decrease a few years before the woman enters menopause however this can be variable and reliability of AMH on predicting menopause should be questioned. Furthermore, the woman may desire fertility preservation by freezing her eggs and this test may be helpful in aiding her decision .

Interpretation of AMH level

AMH level varies based on age and sex and many studies have been performed that show that AMH slowly declines with age. A decreased level may indicate a low number of eggs present within the ovaries however the AMH level is highly dependent on age and naturally decreases as a woman ages. The clinical significance of the outcome of AMH testing can be interpreted somewhat ambiguously. According to Richard Anderson in the Journal of Reproductive Endocrinology on predicting age at menopause, “The term ‘ovarian reserve’ is also used, perhaps more accurately, to mean the pool of primordial/non-growing follicles within the ovary,in otherwords the number of eggs left in the ovary. A much larger study has recently confirmed the predictive value of AMH, but importantly emphasizing that age remains an independent predictor of menopause.”

 

Normal values for AMH level in women under 35
Less than 0.5 ng/ml Very Low
0.5-1.0 ng/mL Low
1.0-1.5 ng/mL Low Normal
1.5-4.0 ng/mL Normal

For example, a woman in her twenties may have an AMH level of 4.0, whereas a woman in her thirties may have a level of around 2.5 ng/mL.

My AMH level is low, do I still have a chance of success with IVF?

It is important to know that even when the AMH results have been reported to be very low, successful pregnancies have still resulted following treatment with IVF,especially in young patients. The AMH level may be a small snapshot into the ovaries of the woman but it does not predict everything that is happening within the ovary. Women considering in- vitro fertilization treatment with a low AMH level should speak with their physician about their potential success rates. Although research is suggestive that a lower amount of eggs may be retrieved following IVF if the AMH level is low, however there are other factors to consider and the reliability of this test should be noted as variable.

When selecting a fertility physician, AMH testing should be explained to the patient in full including that the results may be variable in predicting the body’s response to ovarian stimulation. In addition, other testing should also be performed and AMH should not be used as a sole predictor of ovarian reserve.

If you have been diagnosed with a low AMH level and turned away from IVF treatment by your physician, contact Dr. Shaykh for a second opinion at no charge today!