What is Anti-Müllerian Hormone (AMH)?
Anti-Müllerian hormone (AMH) is a hormone produced by the cells that support the dormant pool of eggs in the ovaries. Therefore, a higher level of AMH suggests a larger pool of eggs (or a greater ovarian reserve). “This is a very useful test for us because it doesn’t tend to fluctuate as much as follicle-stimulating hormone (FSH) levels and it gives us another angle to assess the ovarian reserve. As it pertains to an individual’s fertility, the higher the level, the better,” says Dr. Joseph Doyle, of Shady Grove Fertility’s Rockville, MD office.
Did you know: an AMH level greater than 1 suggests a good ovarian reserve?
AMH levels are determined through a blood test and unlike other hormones, levels do not vary significantly through the menstrual cycle. This means that you can check it on any day of the cycle and it doesn’t tend to vary from cycle to cycle like FSH levels can. Another benefit of AMH is that it provides insight into the estimated number of eggs that could be retrieved during an IVF or egg freezing cycle as well as how much medication will be required for ovarian stimulation during a treatment cycle.
The anti-Müllerian Hormone (AMH): Part of the Initial Fertility Evaluation
Measuring the anti-Müllerian hormone level is now a part of the initial fertility evaluation along with:
- Ultrasound of ovaries to determine antral follicle count (AFC)
- Bloodwork to evaluate reproductive hormones: FSH, estradiol, and luteinizing hormone (LH)
- Hysterosalpingogram (HSG) to check for any blockages of the Fallopian tubes
- Semen analysis to test quality and quantity of sperm in the male partner
These tests, along with your medical, reproductive, and family histories will help your fertility specialist determine the treatment best suited for you. Patients who wish to preserve their current fertility and freeze eggs would not complete the HSG or semen analysis
What is good ovarian reserve vs. decreased ovarian reserve?
The ovarian reserve is the quality and number of oocytes (female eggs) a woman has. A good ovarian reserve means you have a high number of oocytes of good quality, while a poor ovarian reserve would mean you have a lower number of oocytes with decreased quality. The quantity of eggs can be measured through ovarian reserve testing, which evaluates your reproductive hormone levels, including AMH, as well as an ultrasound to evaluate your AFC.
The ovarian reserve steadily and naturally decreases as a woman ages until around the age of 35 when the decline begins to increase until finally reaching menopause. Each woman’s fertility is unique and the quantity of eggs at the time of puberty and the rate of change from puberty to time of menopause varies from woman to woman. This rate of change is partially predetermined by your genetics. Women with a family medical history of early menopause have a higher chance to begin the fertility decline at a younger age.
Age Matters Most
While family medical history is important, the most important modifying factor of a good ovarian reserve is age. Decreased ovarian reserve in a younger patient (<35 years of age) is not necessarily the same as decreased ovarian reserve in an older patient. A younger woman may have decreased ovarian reserve and though the number of eggs present may be decreased, because of her age, the egg quality may still be high. Age, in conjunction with an assessment of ovarian reserve and the other elements of your fertility evaluation and family building goals, will determine your treatment path.
Editors Note: This post was originally published in December 2012 and has been updated for comprehensiveness as of January 2018.
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