Anti-Müllerian Hormone (AMH) is a hormone secreted by the cells of immature (primordial) follicles in the ovaries. These follicles usually hold one egg that can be ovulated during a future menstrual cycle. When a woman is born, she already has all the eggs she will ever have. As she ages, the number of immature follicles that she produces will decrease until she goes through menopause. In fact, as the number of follicles declines, the AMH level decreases as well. This decline in AMH levels is a very clear-cut gauge of a woman's ovarian reserve (OR)...
TICK-TOCK GOES THE BIOLOGICAL CLOCK
In most cases, the chance of conception during each monthly cycle can best be predicted based on a woman’s age. Sometimes though, even with seemingly normal menstrual cycles, the number of available follicles declines faster than normal. In that situation, a woman’s ovarian reserve (the number of healthy follicles available that can be used for successful conception – with or without fertility treatments) can be tested to determine if her biological clock is running faster than expected. The Anti-Müllerian Hormone blood test can estimate a woman’s ovarian reserve by measuring the remaining number of healthy follicles capable of maturing in future cycles.
The AMH level measures a woman’s fertility potential by comparing her numbers with other women in the same age group. If the AMH levels fall below the levels expected for her age, a woman is thought to have "low AMH." Lower than expected AMH levels at any specific age points toward lower chances of conception, even with IVF.
IT'S ALL IN THE NUMBERS
A woman’s fertility reaches its peak when she is in her twenties. Under normal circumstances, as she moves into her thirties, her fertility begins to drops considerably - especially after she reaches the age of thirty-five. Research has shown this marked drop in fertility in many ways and it can easily be seen in a review of IVF pregnancy rates. Statistics show that when women go through an IVF cycle in their mid to late thirties, there is a documented decrease in the chance of an embryo successfully implanting in the uterus. Miscarriage rates also increase with age, especially when a women reaches the age of 40. Of course, the number of normal, healthy eggs available within a woman’s ovaries is specific to the individual. By the time most fertile women pass the age of 40, there are usually only a few remaining eggs available.
WHAT DOES THE AMH VALUE MEAN?
AMH testing is important because, when the test results show a low ovarian reserve (especially in younger women), reproductive specialists can suggest more aggressive treatment plans. Specialists must carefully plan treatment to meet each patient’s individual ovarian reserve status.
Based on information from the American Society for Reproductive Medicine, ovarian reserve testing is especially useful for those women who have a higher risk of reduced ovarian reserve.
Those at risk include:
- Women who are over 35 years old
- Women who have had an ovary removed
- Women who have a known family history of early menopause
- Women who have had some type of ovarian surgery, pelvic radiation or chemotherapy
- Women who have had little response to ovarian stimulation
- Woman who have unexplained infertility
HIGH HOPES FOR LOW AMH
There are several possible treatments for women diagnosed with a low ovarian reserve. Reproductive specialists often recommend IUI or in vitro fertilization (IVF), along with fertility medications. In cases that are predicted to have a low chance of success or where the treatments fail, egg donation is an option. Egg donation has a high chance of success, and embryo donation may also be a viable option for many couples.
TAKING CONTROL OF YOUR FERTILITY
If you have been attempting to get pregnant for more than twelve months (or six months if you are over 35), it is time to seek help. Take control of your fertility and make an appointment with one of our compassionate reproductive specialists at the Center of Reproductive Medicine. Your chances for success increase when you get help sooner than later.
Once you have met with one of the expert specialists at CORM, a treatment plan or a diagnostic testing schedule that is appropriate for your individual needs will be coordinated with you.