Fertility 101: Fertility Testing/Services
AMH (Anti-Mullerian Hormone) Testing
AMH is a marker of ovarian reserve, or remaining egg supply, which is predictive of one’s ability to respond to fertility medications and conceive through fertility treatments. There are several tests for ovarian reserve, but of the three mainly used, two involve blood work and one is an ultrasound.
The ultrasound is performed early in the menstrual cycle to look at the immature follicles, or antral follicles in your ovaries. These are follicles that are residing or “hanging out” waiting to be stimulated into mature follicles that contain mature eggs. The antral follicle count, or AFC, is a count of follicles 2 to 10 mm in size. A low AFC (range of 3 to 10 follicles) has been associated with a lower response to FSH injections and less success at achieving pregnancy.
The day 3 FSH and estradiol levels are blood tests that are not used at Carolina Conceptions. A high day 3 FSH or estradiol level is indicative of decreased ovarian reserve. At Carolina Conceptions, AMH levels are used instead of day 3 FSH/estradiol measurements for a number of reasons.
AMH is secreted by the pre-antral and small antral follicles and is not cycle day dependent enabling it to be drawn as a blood test on any day of the menstrual cycle. There is little variability in AMH levels from month to month, unlike the day 3 FSH level. Hormonal medications, such as oral contraceptives, do not influence AMH levels but will artificially reduce FSH levels. Since AMH is secreted by all of the resting ovarian follicles, a higher value indicates a normal ovarian reserve and is a positive predictor of pregnancy success. A low AMH indicates diminished ovarian reserve and is correlated with difficulty conceiving. Overall lower AMH levels have been associated with, but do not always predict, poorer responses to gonadotropins and poor pregnancy outcomes in IVF (please refer to our IVF stats section of our website to review a graph of AMH levels and IVF pregnancy rates at Carolina Conceptions. As you will note in this paper, presented at the national meeting of the American Society of Reproductive Medicine, AMH levels while predictive of egg yield did not have a major impact on pregnancy rates if egg harvest was performed). As in our experience, studies cannot provide useful AMH cutoff points for clinical practice. So, low AMH levels are specific for predicting a poor ovarian response to FSH injections, but not necessarily predictive for chance of pregnancy.
AMH may be a better predictor of time to pregnancy, than actual chance of conception per cycle in women not undergoing IVF. That is low levels may mean that it is likely going to take a longer time for the women to conceive. This is more comforting than saying that your AMH level means you have no chance at conception. AMH needs to be viewed in the setting of other factors. The patient’s age may be more important than her AMH level. An AMH level of 3 in a 42 year old woman is not equal to an AMH of 3 in a 30 year old.
AMH levels are lower in obese, non PCOS patients and smokers. For women who are obese, losing weight may improve the AMH slightly and improve overall fertility. Quitting smoking will limit the damage that has been done to the egg supply. For those with low AMH, patients should ask their physician about the possible benefit from taking a supplement called DHEA.