Anti-Müllerian hormone (AMH), secreted from granulosa cells of growing follicles, is now recognised as the most important biomarker for OR - better than age alone or other reproductive markers - and pregnancy outcome in assisted reproductive technology cycles. Normal AMH values often exceed 2ng/mL at age 30, 1.5ng/mL at age 35, and 1ng/mL at age 40.^3,4,5

How are AMH levels tested and what factors (if any) can influence results?

AMH levels – often referred to as the egg timer test – are measured through immunoassay on a sample obtained through phlebotomy. Values obtained have the distinct advantage of being equally valid at any point in the menstrual cycle. Because AMH is expressed primarily before follicle-stimulating hormone responsiveness occurs, it is believed that AMH remains a valid assay even when ovarian suppression occurs through smoking, oral contraceptives, gonadotropin hormone-releasing hormone agonists, and pregnancy.⁶

Though these factors can lead to transient ovarian suppression, they are unlikely to change levels so much as to meaningfully underestimate true reserve. The magnitude of effect through these reversible factors seems to be low, with age specific AMH percentiles decreasing by 11% with oral contraceptives and 17% with pregnancy. Additionally, AMH levels drawn on day seven of the pill free interval seem to closely correlate with levels seen after oral contraceptive discontinuation.⁶

Why is it important to do AMH testing in all women of reproductive age?

The American College of Obstetricians and Gynaecologists released a statement 2019 against the use of AMH in women without a diagnosis of infertility as it is not supported by the evidence. However, some fertility specialists and researchers suggest that women in their late 20s have the AMH test at regular intervals to monitor their fertility potential.^7,8

Azhar et al argue that women have the right to know their fertility status, so that they can make informed decisions about their reproductive health. This includes the right to have access to information about their OR. Tests results can help women choose to opt to have fertility treatments if they are concerned about their fertility.⁹

The right to know one’s fertility status is an important part of women’s reproductive health. This right should be protected so that women can make informed decisions about their future.⁹

Evaluation of AMH’s predictive value can play an important role in counselling women about their future reproductive health. The AMH test is a way for women to find out how much longer they have to achieve pregnancy or how likely it is that pregnancy could be achieved at all, potentially encouraging proactive family planning, and preventing childlessness caused by age-related infertility. Interest in AMH testing is also increasing with the rise of elective egg freezing in women concerned about age-related fertility decline.¹⁰

References

1. Li H, et al.The trend in delayed childbearing and its potential consequences on pregnancy outcomes: a single center 9-years retrospective cohort study in Hubei, China. BMC Pregnancy Childbirth, 2022.
2. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Female Age-Related Fertility Decline. Number 589 (Replaces Committee Opinion Number 413, August 2008. Reaffirmed 2022). [Internet]. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/03/female-age-related-fertility-decline
3. Gunasheela D, Murali R, Appaneravanda LC, et al. Age-Specific Distribution of Serum Anti-Mullerian Hormone and Antral Follicle Count in Indian Infertile Women. J Hum Reprod Sci, 2021.
4. Meczekalski B, et al.Fertility in women of late reproductive age: the role of serum anti-Müllerian hormone (AMH) levels in its assessment. J Endocrinol Invest, 2016.
5. Xu H, Zhang M, Zhang H, et al. Clinical Applications of Serum Anti-Müllerian Hormone Measurements in Both Males and Females: An Update. The Innovation, 2021.
6. Deadmond A, Koch CA, Parry JP. Ovarian Reserve Testing. [Updated 2022 Dec 21]. In: Feingold KR, Anawalt B, Blackman MR, et al, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279058/
7. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee opinion no. 773: the use of Antimüllerian hormone in women not seeking fertility care. Obstet Gynecol,
8. Evans A, de Lacey S, Tremellen K. Australians' understanding of the decline in fertility with increasing age and attitudes towards ovarian reserve screening. Aust J Prim Health2018
9. Azhar E, et al. Knowledge of ovarian reserve and reproductive choices. J Assist Reprod Genet, 2015.
10. Copp T, et al. Anti-Mullerian hormone (AMH) test information on Australian and New Zealand fertility clinic websites: a content analysis. BMJ Open, 2021.