how important is AMH in assessing fertility?

Anti-Mullerian Hormone (AMH) testing has enhanced fertility assessment and treatment in the past 2 decades. Initial research showed it to be a reliable predictor of fertility, however in the past 5 years more studies have questioned how much we should rely on it…

  • AMH is considered the most sensitive blood test for measuring a woman's ovarian reserve

  • It shows how active the ovaries are but it isn’t a measure of egg quality

  • It is used as part of your fertility assessment

  • IVF clinics will use it to decide what dosage of medication to start you on

  • It will be low if ovarian reserve is reducing, but it is still possible to get pregnant with low or undetectable AMH levels.

  • It may be raised in PCOS because the ovaries are hyperactive.

  • Results are age specific.  The lab reports will include the reference range for the woman's age.

  • Vitamin D plays a role in regulating AMH so Vitamin D deficiency should be tested for.

how much should we rely on AMH results?

AMH has been shown to be the best blood test to measure ovarian reserve and the most reliable indicator of IVF success

BUT… Not all studies agree

  • a trial in Copenhagen found that AMH levels didn’t relate to the time taken to conceive in natural conception. Natural pregnancy was still possible with undetectable AMH (Hvidman et al. 2017)

  • an American study found that women with low AMH (<0.7 ng/mL) didn’t have a statistically different likelihood of conceiving within 6 months than women with normal levels (Steiner et al. 2017)

  • AMH levels related to the number of eggs retrieved, but not pregnancy rates, women over 40 in first IVF cycles. Patients with extremely low AMH still had a chance of pregnancy (Tokura et al. 2013)

  • AMH used to be regarded as a predictor of how long a women has before menopause. A recent review shows that the rate of decline in AMH varies between women so AMH isn’t a reliable predictor. The review also states AMH to be a poor predictor of pregnancy in natural or assisted conception (Iwase et al. 2018)

more about AMH research

While AMH may not be as reliable as first thought it’s still an extremely useful part of decision making. Information is power when making life plans. While a low AMH shouldn’t trigger fertility despair, it is still an indicator to be taken seriously as part of the overall picture when making decisions.

  • AMH is the best current available blood test measure of ovarian reserve (Broer et al. 2014)

  • AMH is best predictor of IVF success in antagonist cycles (Hamdine et al. 2015)

  • higher AMH levels are associated with higher pregnancy rates for women under 40 undergoing IVF (Chen et al. 2014)

  • AMH and antral follicle count are the most sensitive indicators of ovarian reserve and medication dosage needed during IVF cycles, and help personalise the IVF cycle to the patient (La Marca et al. 2014)

  • AMH was more reliable at predicting eggs retrieved and live birth rate in women undergoing IVF with AMH and antral follicle counts which didn’t seem to agree (Li et al. 2014)

  • AMH may be useful in assessing diminished ovarian reserve in women with autoimmune thyroid disease (Saglam et al. 2015)