Anti-Müllerian hormone (AMH) is a new biomarker that may be the most cost effective marker for women who are trying to get pregnant.
AMH is a hormone produced by small ovarian preantral follicles. As the quantity of eggs in the ovary diminishes, AMH levels also fall. In the ovary, AMH directly affects ovarian follicle growth, as it reduces sensitivity to follicle-stimulating hormone (FSH). Excess AMH may inhibit the ovaries from ovulating, which is a common cause of infertility.
This means that AMH is a solid marker of ovarian reserve. For women trying to get pregnant, knowing their AMH levels can help direct them to the best approach to conceiving. For other women who want to ensure that they don’t end up waiting too late to conceive, AMH is also an ideal indicator.
Here are some of the ways AMH is an efficient, effective fertility gauge of ovarian reserve:
- It can be measured any time: Your doctor can test its levels any day of your menstrual cycle.
- It is a stable marker: There is little change in the marker between cycles.
- It is consistent: Accessing AMH will not vary significantly from lab to lab.
Other markers of ovarian reserve are available, but they have more limitations than AMH, including:
- FSH: This hormone needs to be obtained on the early days of the cycle (day 2,3 or 4), and it needs to be evaluated with estradiol (estrogen) levels. FSH also varies between cycles, so it can be falsely reassuring when drawn by itself or not viewed in conjunction with estradiol levels or with ovarian sonography.
- Antral follicle count (AFC): During an ultrasound of the ovaries, the small 3-6mm ovarian follicles (inside of which should be an egg) are counted in each ovary. The AFC also accurately predicts ovarian response to fertility treatments, but it too is cycle dependent (early is best). Also, it can be falsely reassuring because the small follicles visualized on ultrasound may be either small antral follicles ready to grow OR they could be small atretic (dying) follicles that can no longer grow.
- AMH has been shown to correlate with ovarian response in fertility treatments. Here are some of its implications:
- Very high AMH levels > 3.0 can predict a high risk of Ovarian hyperstimulation syndrome (OHSS) in a cycle. This is a complication seen with injectable fertility medications and can be serious and life threatening. Prevention is key. In addition high AMH levels may be used to diagnose Polycystic Ovary (PCO) syndrome.
Many women have irregular periods, but sometimes the precise reason for the irregularity is hard to determine. High AMH levels may help to diagnose PCO syndrome.
Low levels of AMH can predict cycle cancellations with accuracy. IVF cycles are often cancelled if less than three or four follicles are seen on ultrasound after fertility medications are taken. Although AMH by itself does not correlate directly with live birth rates, it appears that AMH >1.0 is more likely to be associated with successful fertility treatment cycles (no cancellation) and live birth rates.
In contrast, low levels of AMH are associated with higher cancellation rates. In one study, if AMH was <0.7ng/ml, two thirds of the cycles were cancelled.
In an IVF cycle, it appears that AMH is inversely proportional to the following:
- Number of follicles aspirated
- Estradiol levels
- Number of total oocytes retrieved
- Number of total mature oocytes found ( only mature eggs/oocytes can be fertilized and become embryos.
AMH is more significant as a predictor of good outcomes (or bad outcomes), when age is combined with AMH level. It is not a good predictor of implantation and pregnancy rates. Age is still the best marker of quality and of percentage of viable embryos, but together age and AMH can be used to predict outcomes, and in particular cancellation rates.
To summarize, AMH is a great single marker to help tailor treatments and to reliably counsel women who are in the following situations:
- Young women contemplating egg freezing or when to start a family
- Young women with cancer (AMH can be used to measure ovarian reserve before chemotherapy as well as after.)
- Young women with irregular menstrual cycles
- Older women who wish to conceive
For more information about AMH and how it might be the best indicator for your fertility situation, please CONTACT US.