Anti-Mullerian Hormone Testing of Ovarian Reserve

What is Anti-Mullerian Hormone (AMH)?

* 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 because it doesn’t tend to fluctuate through the menstrual cycle so can be measured anytime. 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 the other hormones that were used before to assess ovarian reserve.

How can AMH hormone levels be a fertility test?

*Research shows that the size of the pool of growing follicles is heavily influenced by the size of the pool of remaining primordial follicles (microscopic follicles in "deep sleep”). Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply - or "ovarian reserve".

* With increasing female age, the size of their pool of remaining microscopic follicles decreases. Likewise, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound also decreases.

* Women with many small follicles, such as those with polycystic ovaries have high AMH hormone values and women that have few remaining follicles and those that are close to menopause have low anti-mullerian hormone levels.

AMH levels and pregnancy chances with in vitro fertilization

* Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. In general, having more eggs with IVF gives a higher success rate.

* AMH levels probably do not tell us much about egg quality, but having more eggs at the IVF egg retrieval gives us more to work with - so we are more likely to have at least one high quality embryo available for transfer back to the uterus.

* High AMH levels correlate with low cancellation rates, retrieval of more eggs, higher live birth rates and a high chance for freezing of leftover embryos.

*Low AMH levels (alone) do not predict low IVF success rates in women under 35 Couples should not be excluded from attempting IVF due to low AMH values alone because live birth success rates were reasonable in these cases.

What is a normal AMH level?

What is a normal AMH level? The table below has AMH interpretation guidelines from the fertility literature and from our experience, which has shown that one should not be considering these figures with sharpness

AMH Blood Level
High (often PCOS) Over 28 pmol/L
Normal 10 - 28 pmol/L
Low Normal Range 5 - 10 pmol/L
Low 2 - 5 pmol/L
Very Low less than 2 pmol/L

What is good ovarian reserve vs. decreased ovarian reserve?

Ovarian reserve testing is an indirect measure of the quality and number of oocytes. The ovarian reserve naturally decreases as women age. Each woman is different in where there ovarian reserve starts and the rate of change that occurs. This is partially genetically predetermined.
Good ovarian reserve would mean that you have a high number of oocytes with good function, while poor ovarian reserve would mean you have a lower number of oocytes with decreased function.
The most important modifying factor of 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 combination with an assessment of ovarian reserve and the other elements of your fertility evaluation will determine your treatment path.

Questions & Answers

What will an AMH test tell me?

An AMH test gives us some insight into the remaining quantity of eggs and number of fertile years you may have. However, but it cannot tell us much about the quality of those eggs with the same accuracy.

Do I need an AMH test?

The AMH test is useful if:
* you have been trying to conceive for over six months, and want to check your ovarian reserve is appropriate for your age.
* you are considering IVF or other fertility treatments, as low levels of AMH could indicate a potentially poor response to IVF. Conversely, a high level may indicate an exaggerated response to the IVF medication
* you have had chemotherapy or ovarian surgery and want to know if it has affected your future fertility
* you suspect an ovarian tumour
* you would like to conceive in the future, and just want to understand your current position

How do I get an AMH test?

You just come to the center and ask to do the test! You will not need to pay for anything else except for the cost of test. The results will be available in less than 1 hour if you come before 4 pm, but if you come later than 4; the results will be available next morning (if not a Friday). The results comes with explanatory leaflet.

How much does an AMH test cost?

The cost of doing AMH at GFC is 300 LE ($37)

What if I have low AMH?

If you have a low AMH level, indicating poor egg reserve ask for consultation at the center. You will have detailed 3D ultrasound assessment which will give more detailed insight about ovarian reserve by looking at the size, volume and antral follicle count (AFC) which either confirm the findings of AMH level or question it! Management options will be discussed