What is AMH and what is its clinical value?

Anti-Mullerian Hormone (AMH) is a protein hormone produced by granulosa cells (cells lining the egg sacs or follicles) within the ovary.

AMH can be measured in the blood at any time in the menstrual cycle as it is stable throughout the cycle.

It is a marker for ovarian (egg) reserve. For accurate assessment, it should be combined with antral follicle count – AFC (number of small follicles within both ovaries) as seen on expert fertility (transvaginal) ultrasound scan.

AMH and AFC can help to determine the best strategy for IVF treatment.

Prior to the availability of AMH test, women had to undergo one complete IVF cycle to understand how her ovaries would respond to drugs and to plan further stimulation strategies.

With the availability of AMH blood test, it is not necessary to subject a woman through a standard stimulated cycle unnecessarily for diagnosis of her ovarian response.

Treatment options can be either Natural (no stimulating drugs) or Stimulated IVF. If ovarian stimulation is necessary, the daily dosage of stimulating drugs and protocol can be tailored depending upon the level of AMH in blood.

AMH level can help to identify women who are likely to over-respond to drugs (at risk of ovarian hyperstimulation syndrome-OHSS) and those who are likely to respond poorly to ovarian stimulation.AMH levels are naturally lower in older women (particularly after the age of 40) and higher in women with Polycystic Ovaries (PCO) or Polycystic Ovary Syndrome (PCOS). Normal AMH and AFC levels can be re-assuring for a woman who wants to find out about her egg reserve and fertility potential.

Those who have very low AMH levels and are likely to respond poorly to drugs can consider having Natural IVF (no stimulating drugs) treatment if they wish to try with their own eggs.

Success can be achieved with low AMH but the success rates are low.

Interpretation of AMH results (As per TDL Laboratories, London)

Ovarian fertility potential                  Values per 2nd generation assay

(TDL)Optimal fertility                                       40.04-67.9pmol/l

Satisfactory fertility                                         21.98-40.03pmol/l

Low fertility                                                     3.08-21.97pmol/l

Very low/undetectable                                    0.0-3.07pmol/l

Please discuss your AMH results and its implications on your fertility including treatment options with your consultant.