By Pedro Royo Manero (Gynecologist – License No. 312203918).
The anti-Müllerian hormone AMH is a biomarker of a woman's ovarian reserve. AMH is a glycoprotein which, in women, is produced by the granulosa cells of the ovarian follicles. This hormone has the potent ability to present itself as a biomarker of ovarian reserve, i.e., the number of eggs a woman has at any given time.
Anti-Müllerian hormone (AMH) is well known in assisted reproduction processes as one of the main indicators of a woman's ovarian reserve.
Below, we will provide an in-depth understanding of the function of this protein, the mechanisms by which it is measured and the interpretation of its levels in patients seeking pregnancy.
Knowing the levels of anti-Müllerian hormone allows reproductive medicine specialists to have more information about the fertility status of their patients, as well as to predict their response to ovarian stimulation in assisted reproduction treatments.
The ovarian reserve is the number of eggs a woman has and it varies according to her age. This is why ovarian reserve plays a decisive role in female fertility.
A woman's low ovarian reserve can reduce her chances of pregnancy. However, a woman's high ovarian reserve is not the only factor in determining her pregnancy. The quality of the eggs also plays an important role here.
The analysis of the anti-Müllerian hormone AMH - always included in the ovarian reserve tests - is one of the tests that IVF-Life experts recommend to their patients, as it allows a preliminary diagnosis to be made, other relevant tests to be ordered and a course of treatment to be established.
According to the Spanish Fertility Society (SEF), it is important to stress that the values of anti-Müllerian hormone do not indicate the quality of a woman's eggs, but rather an estimate of the number of eggs that would be viable after hormonal stimulation.
Measuring AMH is simple and non-invasive for the patient, as it only requires a blood test. In principle, the test could be taken at any time during the cycle, as the ovarian reserve does not change during the cycle.
However, as the expression of AMH is influenced by other hormones (e.g. FSH), it is always recommended to perform the ovarian reserve test between days 3 and 5 of the cycle, i.e. at the onset of menstruation.
Anti-Müllerian hormone results are generally shown in nanograms per millilitre (ng/ml) and, while each clinic, laboratory or even country is guided by different reference values, they all tend to be fairly similar.
For reasons such as these, it is always essential that, regardless of being aware of the reference values, the results are interpreted by an expert team in assisted reproduction together with other relevant information, such as that obtained by ultrasound in an antral follicle count or in the analysis of other hormones (FSH, LH or oestradiol).
One determinant of ovarian reserve is age. As a woman gets older, the quantity and quality of her eggs decreases, reaching a peak in her mid-thirties and becoming almost depleted as she approaches the menopause. Consequently, AMH levels are also declining.
In this context, it is important to note that there are women who have a low ovarian reserve even though they are still young -biologically speaking-. These cases are usually associated with an unhealthy lifestyle, genetic factors or specific medical reasons, such as chemotherapy treatments, having undergone ovarian surgery or being diagnosed with certain conditions (early menopause, autoimmune diseases, endometriosis, etc.).
It is necessary to emphasise that the experience of IVF-Life's assisted reproduction specialists has made it possible for hundreds of patients with low ovarian reserve to achieve pregnancy.
Even though the prognosis of an in vitro fertilisation treatment for a patient with a low ovarian reserve may be less favourable - due to the subsequent low response to stimulation - our experts in reproductive medicine have specific and personalised protocols to deal with your case in an ideal way.
For example, it should be borne in mind that a low ovarian reserve does not always imply poorer oocyte quality. That is why at IVF-Life we avoid carrying out a massive stimulation that ends up ‘stressing’ those oocytes that could be functional.
Properly calculating the doses of gonadotropins to be administered to each patient is essential when it comes to making your success our priority. So is making the most promising treatments available to you, such as ovarian rejuvenation techniques or oocyte donation.
While many women and couples see egg donation treatments as a last resort, due to the still lingering stigma created around it and the genetic grief that is sometimes experienced, at IVF-Life we encourage you to see it as a powerful decision for patients who, like you, are seeking pregnancy.
Practice Committee of the American Society for Reproductive Medicine.
Testing and interpreting measures of ovarian reserve: a committee opinion.
.
2020;
1151-1157
Guía clínica de la Sociedad Americana de Medicina Reproductiva que revisa cómo evaluar e interpretar la reserva ovárica mediante la hormona antimülleriana (AMH), la hormona foliculoestimulante (FSH) y el recuento de folículos antrales (RFA):
https://pubmed.ncbi.nlm.nih.gov/33280722/
Moolhuijsen LME, Visser JA.
Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function.
.
2020;
3361-3373
Revisión científica sobre la utilidad clínica de la hormona antimülleriana como marcador de la reserva ovárica:
https://pubmed.ncbi.nlm.nih.gov/32770239/
Salemi F, Jambarsang S, Kheirkhah A, Salehi-Abargouei A, Ahmadnia Z, Hosseini HA.
The best ovarian reserve marker to predict ovarian response following controlled ovarian hyperstimulation: a systematic review and meta-analysis.
.
2024;
303 (volumen 13)
Revisión sistemática y metaanálisis que compara la capacidad de la AMH, el recuento de folículos antrales, la FSH y el estradiol para predecir la respuesta a la estimulación ovárica controlada:
https://pubmed.ncbi.nlm.nih.gov/39695880/
Peigné M, Bernard V, Dijols L, Creux H, Robin G, Hocké C.
Using serum anti-Müllerian hormone levels to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis.
.
2023;
1789-1806
Revisión sistemática y metaanálisis que estudia si los niveles séricos de AMH permiten predecir la probabilidad de nacimiento tras la concepción espontánea o mediante reproducción asistida:
https://pubmed.ncbi.nlm.nih.gov/37475164/
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