| AMH levels assess ovarian reserve |
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Recently, a new hormone marker, anti-Müllerian hormone (AMH), has been evaluated as a marker of ovarian reserve. AMH is produced solely in the granulosa cells of small ovarian follicles. Recent reports indicate that AMH levels decline with increasing female age and that initial AMH is associated with ovarian response in IVF patients with normal FSH levels. AMH levels seem to correlate with other measures of ovarian reserve such as the the antral follicle count or FSH level.
Serum AMH levels from women are lower than those in men throughout life. One potential advantage of using AMH as a marker of ovarian reserve is that it does not seem to change over the course of the menstrual cycle. FSH, on the other hand, must be measure on Day 2 or Day 3 of the menstrual cycle or on Day 10 if it is drawn as part of a clomid challenge test. Most commercial labs are not accustomed to determining AMH levels on fertility patients. The cutoff values for normal should therefore be determined by the fertility doctor based on the outcomes of the patients. For example, percentile ranking can determine where a particular patient's levels fall in relation to other women with infertility or women with known good fertility (such as egg donors). At IVF1, as of December 2007, 95% of infertile women have an AMH level higher than 0.365. The 50th percentile or mean level is the point at which 1/2 of the patients have higher levels and 1/2 have lower levels. The 50th percentile for AMH is 2.48. The highest level seen in our practice to date is an AMH level of 10. We have counseled women who have an AMH level in the bottom 5 to 10 percent that they have significantly decreased ovarian reserve. |
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| Last Updated ( Thursday, 31 January 2008 ) |
