Hormone test shows fertility potential in women
It is natural for a woman to wish to have an idea of her potential fertility. A measurement of the anti-Mullerian hormone (AMH) concentration has become the most commonly used test of “ovarian reserve” – a term that refers bothto the number of oocytes within the ovary and their fertility potential. Ovarian reserve, orthe number of releasable oocytes, declines with ovarian age, which does not always equatewith the age of the woman.
At 23, Mary isn’t in a hurry to have children. But two years ago, she discovered she had reason to worry about her fertility.Mary visited her gynecologist because she was having irregular periods. When some tests indicated abnormalities, he recommended her to perform an anti-Müllerian hormone test.The blood test indicated she had fewer remaining eggs than is typical for a woman her age and that becoming pregnant might become difficult later on.“That would be the most devastating to me, to think I could never have kids,” said Mary, a student at Texas Tech University, School of Medicine.
Mary plans to freeze her eggs so they will be available if she cannot conceive when the time is right.
The anti-Müllerian hormone is a substance produced by egg sacs in the ovaries, and a growing body of research suggests the level of the hormone is an indicator of fertility potential.
Measuring AMH also gained paramount importance in clinical practice of IVF centers to recommend the most appropriate controlled ovarian stimulation protocols to patients. AMH values are also used in the prediction of poor or excessive ovarian response.
What can AMH predict in the IVF protocol?
Anti-Mullerian hormone is the molecule of the moment in reproductive medicine, with a growing recognition that could revolutionize reproductive endocrinology. Currently, the main field of application for the measurement of AMH remains in vitro fertilization. In this respect, the AMH demonstrates its usefulness in following directions:
- prediction of poor or exaggerated response to ovarian stimulation;
- individualization of treatment strategies;
- counseling couples about the probability of conceiving after ART treatment;
- prediction of live born babies.
Optimal assessment of women and appropriate treatment are essential in successful outcomes in assisted reproductive technologies (ART). For optimal results, it is necessary to assess ovarian reserve before planning treatment. Identifying patients with poor or excessive response before treatment can reduce cycle cancellation rate and adverse effects such as ovarian hyperstimulation syndrome.
AMH stability during a menstrual cycle and its predictive ability recommend it the best hormonal prognostic marker of ovarian response in assisted reproductive techniques.
AMH – predictor of long-term fertility
AMH is promoted as a predictor of long-term fertility. Normal levels of AMH may offer insurance, but we do not know how long it will take to decrease the AMH level. However, recent AMH-age nomograms recorded results that illustrate the average annual decrease of AMH in women of reproductive age, providing a perspective of the annual decline in women.
Diagnosing polycystic ovarian syndrome
AMH level is significantly 2 to 3 times higher in women with anovulation, thus including polycystic ovarian syndrome. This concentration is significantly reduced in premature ovarian failure, while it remains unchanged in hypogonadotrophichypogonadism and hyperprolactinemia compared with women with normal ovulation.
Given the unique relationship between AMH and the number of primordial follicles, it has the ability to predict menopause. Ovarian aging and premature ovarian failure have been associated with very low and almost undetectable levels of AMH. AMH decreases with age and continue to decrease until it reaches a stage where it becomes undetectable after menopause.
- La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, Stabile G, Volpe A. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 2010c;16: