Anti-Mullerian Hormone (AMH) Test and Ovarian Reserve.

Dr Sebastian Leathersich | Fertility Specialists of WA, Claremont.

Fertility specialists will commonly request an Anti-Mullerian Hormone (AMH) blood test as one of the first medical assessments for new patients.

There are two main reasons we use this test – firstly, as an initial indicator to evaluate a patient’s egg reserve, and secondly, to test their response to fertility medication.

Notably, the results of an AMH test are best interpreted by a fertility specialist, and the gold standard test to determine egg reserve is an antral follicle count (AFC). This transvaginal ultrasound counts ovarian antral follicles. An AFC is done ideally in the first half of a woman’s cycle, before ovulation.

What is the Anti-Mullerian Hormone (AMH)?

The Anti-Mullerian Hormone is produced by the small follicles in the ovary which have not yet begun to develop into mature eggs or ova. These early-developing follicles are called antral and pre-antral follicles.

The AMH controls the development of the follicles that the eggs develop from. Its role in the ovary is to limit the progression of all but a very few of the eggs to the final stage, preparatory to ovulation. AMH is produced by the cells surrounding each of the eggs with levels correlating with the total number of viable eggs (or the ovarian reserve).

However, AMH levels do not measure the quality of the eggs, which is also very relevant for success.

The amount of AMH in the blood usually remains constant until age 25, then begins to decline. A steady decline of AMH occurs from age 35 until it becomes unmeasurable at menopause.

About the AMH Test:

The AMH blood test can be performed at any time throughout the menstrual cycle. It may be performed in conjunction with an antral follicle count (simple ultrasound) as a predictor of your ovarian reserve.

An AMH test is a good snapshot of your current ovarian reserve. However, it is recommended to treat ‘normal results’ with caution. Ongoing monitoring is wise as AMH levels decline at predictable rates.

Patients must also remember that egg reserve levels are only one of the many factors that can impact your fertility. It is, therefore, essential for this test to be ordered by gynaecologists and fertility specialists who are trained to interpret the results and explain them in detail to the patient involved.

AMH testing to check your fertility status:

Your doctor may recommend an AMH test if:

  • you are having ongoing trouble falling pregnant
  • you want to delay childbirth and are under 35 years old
  • you are concerned about medical conditions that may have an impact on your fertility, like a family history of premature menopause, multiple operations on the ovaries, chemotherapy, endometriosis, or polycystic ovarian syndrome.

Importantly, fertility can still be higher for younger patients at lower levels of AMH (compared with older patients with similar levels), as egg quality is usually better when younger.

AMH testing to predict ovarian response in fertility treatments:

If you are undergoing fertility treatment, your specialist may choose to do an AMH test to predict ovarian response to fertility medication and as this helps in deciding the dose of medication (FSH) to be used.

What can AMH test results indicate?

A low ovarian reserve result may indicate:

  • It may be better to consider your options for starting a family sooner rather than later.
  • Further assisted fertility methods should be considered depending on the situation and age.
  • If already undergoing treatment, it may call for a larger dose of fertility medication.

It is important to note that many patients who have low AMH levels can still fall pregnant.

A high ovarian reserve level may indicate:

  • Polycystic ovary syndrome (PCOS) – people with PCOS have high levels of AMH (often above the 97.5 percentile for age), which should drop with the appropriate treatment a fertility specialist provides.