As the age of first conception increases, more women are seeking reassurance about their reproductive potential. Until recently FSH measurement was the principal biochemical marker available but was only of limited value. Anti Mullerian Hormone (AMH), produced by the ovaries now appears to be a more sensitive predictor of ovarian reserve.
What is AMH?
Anti Mullerian Hormone or AMH is a hormone secreted by very early ovarian follicles. A growing body of research has demonstrated that measuring the concentration of AMH in a woman’s blood has been shown to be a good predictor, of a woman’s egg reserve.
A low AMH level indicates a low egg reserve and high levels of AMH can be indicative of PCOS.
AMH can be used in conjunction with specialised ultrasound to give the most accurate picture possible of a woman’s future fertility.
A very important advantage is that the AMH level remains constant or only fluctuates mildly, throughout the menstrual cycle, so that AMH can be measured at any time during a cycle, and the test can also be taken while a woman is using the oral contraceptive pill.
Who should be tested?
Women considering IVF and other fertility treatments as AMH levels are seen as a good predictor of IVF success. Low levels may indicate a possible poor response to the drugs used in IVF. AMH also identifies women at risk of OHSS
- Younger women considering delaying child-bearing
- Women who have had chemotherapy or ovarian surgery and want to find out what effect it has had on their future fertility
Measurement of the serum AMH level requires a single 5ml blood collection at any time of a menstrual cycle.
The sample needs to arrive at the IVFAustralia laboratory within 24 hours of collection. Tests are run regularly and results are forwarded to the ordering doctor within seven days.
The fee for testing AMH is $75. This fee is not claimable from Medicare. A collection fee may also be charged if no other Medicare claimable tests are required.
Treatment implications of a low serum AMH
It is important to remember that the AMH concentration ONLY reflects the number of eggs and gives no information about the quality of the eggs. Indeed, there are several reported cases of women with undetectable levels of AMH who have achieved a natural or IVF pregnancy.
Counselling of patients with low levels of AMH must therefore include discussion about the uncertainty of conception.
However, it seems very likely that a low AMH concentration gives advance warning of a premature decline in fertility. Women with this finding, who are having difficulty conceiving, should, therefore, be considering whether to move onto more advanced fertility treatment protocols at an earlier stage than they otherwise would do.