AMH and fertility - how important is it?

Anti-Mullerian Hormone (AMH) testing has enhanced fertility assessment and treatment in the past 2 decades. Initial research showed it to be a reliable predictor of fertility, however in the past 5 years more studies have questioned how much we should rely on it.

  • AMH shows how active the ovaries are but it isn’t a measure of egg quality

    • It will be low if ovarian reserve is reducing

    • It may be raised in PCOS because the ovaries are hyperactive - it has been suggested this may be due to the effect of insulin (Liu et al. 2019)

    • It can also be raised if you have endometriosis cysts on your ovaries (Marcellin et al. 2019)

  • results are age specific - the lab reports will include the reference range for the woman's age

  • IVF clinics will use it to decide what dosage of medication to start you on

  • UK and USA results are reported differently - picomoles (pmol/L) in the UK and nanograms (ng/ML) in the USA - 6 pmol/L is equal to 2.67 ng/ML so USA levels will appear lower in the literature

amh - why a low result shouldn’t trigger fertility despair

AMH has been shown to be the best blood test to measure ovarian reserve and the most reliable indicator of IVF success

BUT… Not all studies agree

  • a trial in Copenhagen found that AMH levels didn’t relate to the time taken to conceive in natural conception. Natural pregnancy was still possible with undetectable AMH (Hvidman et al. 2017)

  • an American study found that women with low AMH (<0.7 ng/mL) didn’t have a statistically different likelihood of conceiving within 6 months than women with normal levels (Steiner et al. 2017)

  • AMH levels related to the number of eggs retrieved, but not pregnancy rates in women over 40 in their first IVF cycles. Patients with extremely low AMH still had a chance of pregnancy (Tokura et al. 2013)

  • AMH used to be regarded as a predictor of how long a women has before menopause. A recent review shows that the rate of decline in AMH varies between women so AMH isn’t a reliable predictor. The review also states AMH to be a poor predictor of pregnancy in natural or assisted conception (Iwase et al. 2018)

Amh - still important for fertility decisions

While AMH may not be as reliable as first thought it’s still an extremely useful part of decision making. Information is power when making life plans. A low AMH shouldn’t equate with lack of hope, but is still an indicator to be taken seriously as part of the overall picture when making decisions and planning timelines

  • AMH is the best current available blood test measure of ovarian reserve (Broer et al. 2014)

  • AMH is the best predictor of IVF success in antagonist cycles (Hamdine et al. 2015)

  • higher AMH levels are associated with higher pregnancy rates for women under 40 undergoing IVF (Chen et al. 2014)

  • AMH and antral follicle count are the most sensitive indicators of ovarian reserve and medication dosage needed during IVF cycles, and help personalise the IVF cycle to the patient (La Marca et al. 2014)

  • AMH was more reliable at predicting eggs retrieved and live birth rate after IVF when the AMH level and antral follicle count didn’t seem to agree (Li et al. 2014)

  • AMH may be useful in assessing diminished ovarian reserve in women with autoimmune thyroid disease (Saglam et al. 2015)