Antimullerian Hormone and Fertility
One of the main causes of infertility is aging of the ovary.
Decline in fertility with age is explained by a decline in the number of follicles (eggs) as well as a decline in the quality of the eggs. Chronological age alone is a very poor predictor of true “ovarian age”. Multiple tests such as day three follicular stimulating hormone (FSH), estradiol , Inhibin B and antral follicle count by sonography have been used to try and estimate the remaining number of follicles. Limitation of these tests are presented by the fact that those tests need to be performed on a specific day of the menstrual cycle, the levels of those hormones tend to fluctuate from one month to another and also tend to change relatively late in the reproductive aging process.
- Follicular stimulating hormone level (FSH) : FSH is a hormone produced by the brain that stimulates the growth of follicles (eggs) in the ovary. With increasing age there is a decline in the number of the remaining eggs in the ovary and the level of this hormone increases. FSH should be checked at a specific time of the menstrual period, between the second and third day of the menstrual period. A high serum level of FSH usually signifies a decreased number of eggs in the ovary.
- Estradiol level: Estradiol level is usually checked in combination with an FSH level. Estradiol is produced by the growing follicles. As women age the level of estradiol tend to increase. Estradiol and FSH need to be checked on a specific day of the menstrual cycle, usually during the second or third day. A“ high” estradiol level usually signifies a decreased number of eggs in the ovary.
- Antral follicle count – counting the number of “antral follicles” in the ovary on the second or third day of the period. A “low” number of antral follicles usually signifies a decreased number of eggs in the ovary.
What is AMH?
Anti müllerian hormone (AMH), is produced during male fetal life in order to prevent the growth of the uterus and tubes in the male reproductive tract. It is not produced by female fetuses until the end of the pregnancy. In the female fetus AMH is produced by the granulosa cells (cells which surround the egg) . Many studies have shown that serum AMH concentration highly correlates with the number of eggs in the ovary as well as the number of eggs retrieved in patients undergoing In vitro fertilization (IVF). A simple way of viewing this – a patient with a higher AMH level is more likely to produce more eggs/embryos during an IVF cycle compared to a patient with a lower AMH. When AMH was compared to other tests that evaluate the “ovarian age”, AMH was found to be more reliable in estimating the remaining number of follicles.
Advantages of AMH compared to other “ovarian reserve” tests:
- AMH can be tested at any point of the cycle.
- AMH does not seem to fluctuate between one month to another, making it a more reliable and precise marker of true “ovarian aging”.
- AMH changes gradually with age giving us an early sign of the “aging” ovary.
Who should be tested for AMH?
The main indications for AMH testing are:
- Women aged 35 or older with infertility or concern about their fertility.
- Any women aged 35 or older that is planning to undergo an IVF cycle.
- Women undergoing chemotherapy or radiation therapy – it is recommended that the AMH level will be checked before the initiation of treatment and after.
- Women younger than age 35 who are suspect to have decreased number of eggs due to low response to fertility medications, low number of follicles on sonogram etc.
What is considered a good AMH level?
AMH level can vary based on the laboratory. At the Center for Fertility & Gynecology, here in the Los Angeles area, we consider a “good “ AMH 1.5 ng/ml or above, “ok” AMH 1ng/ml-1.5ng/ml, “low” AMH < 1 ng/ml
If my AMH is low does that mean that I can’t get pregnant?
No, a low AMH tells us that you most likely have a decreased number of follicles in the ovary and that you might respond less to fertility medications that are used during fertility treatments such as IVF.
What can I do if I have a low AMH?
We would recommend that you consult with a fertility specialist. There are many fertility treatments and protocols that can be used successfully in women with a low number of follicles. If you have any additional questions regarding fertility testing and AMH please contact the Center for Fertility and Gynecology" at firstname.lastname@example.org