How AMH has Improved Fertility Treatment

AMH Medical Contributor: Stephanie Beall, M.D., Ph.D.

Over the past year, studies have emerged (and SGF 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. The test results provide your clinical team with a better understanding of how your ovaries will respond to ovarian stimulation and which treatment option will work best for you.

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. As our use and understanding evolves, we continue to modify our testing and protocols to maximize pregnancy success.

Many patients have questions regarding their AMH and what it reveals about their current fertility, these are the most common:

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 is AMH tested? AMH results are taken from a simple blood test. The levels of AMH are fairly constant throughout a woman’s menstrual cycle; therefore, a big advantage of AMH is that it can be measured any time during the cycle. Results are typically available within 24-48 hours.
What does my AMH level tell my physician? 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 is used to help predict how a woman will respond to fertility treatments.
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, AMH testing is now part of the standard fertility evaluation for all patients at Shady Grove Fertility. It is ordered in conjunction with FSH, estradiol, and an antral follicle count to give a more comprehensive evaluation of quantity of a woman’s remaining eggs.
How do the results of my AMH level impact my fertility treatment? AMH can be used to evaluate not only a potential low response to stimulation medication, as is seen in patients with a decreased ovarian reserve, but also for 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 high AMH level, the physician will tailor their stimulation protocol accordingly to allow for the best outcomes.
Can I test my AMH if I am on a contraceptive? In a recent study, it was 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. Based on this new study, if a patient is found to have a low AMH and they are on oral contraceptives, one may want to consider retesting the AMH after stopping the hormones for a month.
How much is an AMH test and is it covered by insurance? At Shady Grove Fertility, 90% of women with insurance have coverage for this part of a fertility evaluation. If insurance coverage is not available, the cost ranges from $70 to $139, depending on the lab.
How does PCOS impact my AMH level? Women with polycystic ovarian syndrome (PCOS) have a higher number of early antral follicles resulting in higher baseline AMH levels. AMH levels may be correlated to PCOS severity and have been found to be higher in women with insulin resistant PCOS.
Who should test my AMH level? AMH testing can be ordered by medical providers including your primary care physician, OB/GYN, or Reproductive Endocrinologist as part of a fertility evaluation. Due to AMH’s ability to identify a diminished ovarian reserve — better than FSH — test results can give providers information earlier regarding a potentially serious fertility problem.